Physicians writing on KevinMD about cancer: the screening argument that has run since 2009, how a diagnosis is delivered, what treatment costs patients, life after treatment, and what the work does to oncologists. Four maintained records draw on this archive: Cancer: what physicians say, in their own words, End of life: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Opioids: what physicians and pain patients say, in their own words.

Experimental treatments: When patients want something outside of standard of care

Conditions and Diseases
September 26, 2017

asco-logo I was reading my emails this morning and came across one from the Foundation for Women’s Cancers, announcing September as Gynecologic Cancer Awareness Month. Their social media campaign centered on the hashtag #sharethepurplelove, and the focus on clinical trial awareness and participation. It got me thinking again about the enterprise of clinical trials, and just …

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Experimental treatments: When patients want something outside of standard of care

A glimpse behind the scenes to make your test happen

Physician
September 22, 2017

I am not the first physician blogger to write about the difficulties of prior authorizations, denials, and appeals, but recent occurrences in my own practice have been so convoluted that I feel they must be shared.

The nonsensical denials would almost cause one to laugh, if not for the reality that each denial represents potential delay in care for the patient and redundant work for the physician. That’s work that expands …

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A glimpse behind the scenes to make your test happen

This October, share the message of early breast cancer detection

Conditions and Diseases
September 19, 2017

I love breast cancer awareness month. As a breast medical oncologist, it gives me an opportunity to spread the message of how important early detection is for improving the success of breast cancer treatment. I am surprised regularly at the number of women who either are not doing mammography at all or who do it every couple of years when they remember. We know that women who are participating in …

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This October, share the message of early breast cancer detection

When we are in need, we crave someone who knows us

Physician
September 11, 2017

During elementary school, I saw my dad mostly on weekends, because he traveled for business during the week. Between watching soccer games and running errands, he never missed an opportunity to tune the radio to Car Talk. He is an engineer with a passion for cars, and Car Talk was his Holy Grail. He would guess what was wrong before the expert hosts spoke, and he was usually right. “Aha, I knew it …

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When we are in need, we crave someone who knows us

Cancer doesn’t take away from the beauty of life

Physician
September 10, 2017

As an oncologist, I have spent my career learning how to break bad news. I am still not entirely sure how to tell my children about the tumor in my pancreas, why I will be gone from our home next week for a Whipple operation, or my excuse for abstaining from wrestling matches for the foreseeable future.

I am blessed with two kids, temperamentally diametric: a careful, sagacious nine-year-old daughter and …

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Cancer doesn’t take away from the beauty of life

A cancer survivor embraces the light of going to medical school

Medical Education
September 8, 2017

This article was originally presented as student remarks at the 2015 Harvard Medical School commencement. 

At the end of medical school, I always return to a musing, a zen koan of sorts from Dean Jeffrey Flier. At my white coat ceremony, a close friend and current resident, Dr. Nina Gold was chatting with the dean about the heft of our newly bestowed bright white coats. He asked her, in one beautiful …

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A cancer survivor embraces the light of going to medical school

After 8 years, this doctor is finally treating his pancreatic tumors

Conditions and Diseases
September 6, 2017

I’ve known that I’ve had tumors in my pancreas since 2009. Until now I’ve done nothing about them.

This might sound like a counter-intuitive, even foolhardy strategy, especially for an oncologist, who should surely know better than to let his disease gain an advantage through his own inaction. But I don’t have the “usual” type of pancreatic cancer, the kind that claimed the life of Patrick Swayze and has sentenced many …

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After 8 years, this doctor is finally treating his pancreatic tumors

Dear insurance doctor: You are not my peer

Physician
September 1, 2017

I am a gynecologic-oncologist. I work in the high-stakes realm of cancer care. I strategize complex treatment plans involving surgery, radiation, chemotherapy and the newer biological agents to treat the myriad of disease that we call collectively “cancer.” Cure — or at least control — requires urgent and timely administration of these modalities along with various imaging or blood work to assure that the treatment prescribed is effective. I love …

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Dear insurance doctor: You are not my peer

The white coat symbolizes 2 important commitments

Medical Education
August 27, 2017
YouTube video

A white coat ceremony address to the University of California, Riverside School of Medicine, August 4, 2017.

“It takes a village” is one of my favorite proverbs, an African proverb, that resonates with each of us on this monumental day. There is without a doubt that every one of you worked very hard to get into medical school. However, this difficult journey was supported by dozens of important individuals: teachers, …

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The white coat symbolizes 2 important commitments

Patient first: How EHRs can better serve our shared mission

Health Technology
August 27, 2017

An exchange between former Vice-President Joe Biden and EPIC CEO Judy Faulkner at a Biden Cancer Initiative event has again elevated the discussion of patient access to their medical records.

You can read the discussion on Politico. However, Biden’s main point was that patients needn’t justify their claim to their own EHR records.

In fairness to Ms. Faulkner, they did express a common view: medical records are too complex for …

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Patient first: How EHRs can better serve our shared mission

MKSAP: 58-year-old man with cancer of the ascending colon

Conditions and Diseases
August 26, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 58-year-old man undergoes follow-up evaluation for cancer of the ascending colon diagnosed 3 weeks ago. Colonoscopy at that time revealed a fungating mass in the ascending colon. Biopsy revealed adenocarcinoma, and additional studies showed no evidence of metastatic disease. Right hemicolectomy was performed. The pathology report showed a 4-cm primary adenocarcinoma …

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MKSAP: 58-year-old man with cancer of the ascending colon

Health care at the N of 1

Patient
August 24, 2017

In the past few weeks, there has been a question regarding my use of the hashtag #Nof1 along with how I end the majority of my posts and tweets: Health care is delivered at the N of 1.

One person even believed there might be a trademark infringement with the company N-of-1 who provides molecular testing for patients and then delivers evidenced-based medical recommendations for oncology patients. The reality is that, …

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Health care at the N of 1

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Let’s change the mediocre status quo of health care

Patient
August 18, 2017

On a daily basis, I am introduced to new people from all walks of life. Some sit on the board of directors, some are CEOs, some are presidents, some are middle managers and other administrators, some are investors, others are entrepreneurs, and some are physicians, nurses, case managers and even patients.

I listen to people talk about the big challenges in health care. It costs too much, we have a shortage …

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Let’s change the mediocre status quo of health care

Doctors: Don’t emotionally detach

Physician
August 18, 2017

“He is the best physician who is the most ingenious inspirer of hope.”
– Samuel Taylor Coleridge

I was a third-year medical student on a Sunday morning when the reality of what I had chosen as my life career truly hit me in the gut. At that moment, I realized how intimate the practice of medicine was and that I would have to bring not only my brain and skills to work …

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Doctors: Don’t emotionally detach

A cancer patient’s incredible response to treatment

Physician
August 9, 2017

asco-logo I’d known her for almost 3 years. She had advanced ovarian cancer — clear cell — and was diagnosed with disease already in her chest, stage IV. She had a terrific response to neoadjuvant chemotherapy, which had resolved her extra-abdominal disease sites after three cycles. She had an aggressive interval surgery which achieved complete resection …

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A cancer patient’s incredible response to treatment

A medical student is diagnosed with cancer. Here is his story.

Conditions and Diseases
August 2, 2017

I began medical school, like many of my peers, with some experience working with patients. I worked as a volunteer EMT with Cornell University EMS for four years during my undergraduate years; shadowed a cardiologist and an anesthesiologist through Cornell’s Urban Summer program at NYP Hospital–Cornell and worked with patients during Global Medical Brigade trips to rural Honduras. All of this sparked my interest in medicine, but to claim I …

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A medical student is diagnosed with cancer. Here is his story.

When an erythrocyte sedimentation rate leads to a serious diagnosis

Conditions and Diseases
August 1, 2017

In Sweden, back when I trained, three blood tests were the “routine labs” done at most doctor visits: hemoglobin, white blood cell count, and erythrocyte sedimentation rate. I’m trying to remember, but I don’t think everyone waited an hour to see the doctor, so they must have used a modified rapid sedimentation rate.

The “sed rate,” or “sänkan” as we call it, was invented by Robin Fåhraeus, a relative of one …

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When an erythrocyte sedimentation rate leads to a serious diagnosis

Cancer patients can’t afford care

Physician
July 28, 2017

Lost in the debate on “Trumpcare” versus “Obamacare” is the proper consideration of the factors driving increasing health care costs. In cancer, the pharmaceutical industry plays a major role setting drug prices that exceed reasonable returns on research and development. The economics of treatment were again apparent during the plenary session of the American Society of Clinical Oncology Annual Meeting in June, aka the cancer community’s Super Bowl. Two years …

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Cancer patients can’t afford care

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