Most times, I feel excited to be an oncologist. Oncology research is accelerating and every week brings more news, whether it be a deeper understanding of tumor genomics, a broader understanding of cancer genetics and risk, and, it seems, more ways to provide precision therapy. Studies are coming out showing gains in survival in many different cancers, and …
A reminder that there are no guarantees with cancer
The phone rang in my office one morning last week.
Woman: “I received a notice of an appointment with you, and it says to bring my partner or spouse with me. This problem has nothing to do with him.”
(The opening statement could just as easily be from a man, and often is.)
I quickly looked up her notes in the electronic medical record …
After cancer treatment, sexual health challenges are often shielded from partners
It’s a typical chaotic day on the hospital’s hematology and oncology floor. I’m sitting in a side room with one of my fellow medical students, doing paperwork and making follow-up calls for our medical team.
That’s when the music starts. The sounds of two guitars, a tambourine, and a few maracas drift down the hallway. I can’t make out how many people are singing, but the happy voices and the song’s …
A moment of sorrow transformed into bliss
Autonomous dissection by the internet. We all do it, but is taking an online medical selfie really a good thing? Disease, prognosis, and treatment explained in exquisite, exhaustive, confused, nonspecific and erroneous detail, which often yields the wrong diagnosis, recommendations for irrelevant therapy and wildly inaccurate conclusions, resulting in confusion and fear. Given this common reality, should patients avoid computer self-investigation entirely and leave e-research to the “professionals?”
The bad
Patients, left …
Is taking an online medical selfie really a good thing?
Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, …
There are limits to what a careful physician can do
If someone had told me even ten years ago that I would retire young and become an itinerant radiation oncologist, I would have thought he had lost his mind. As the career medical director of community-based cancer centers, I was used to running the show. And as the saying goes, I ran a “tight ship.” Consultations were performed and documented in a timely fashion, day of the request if the …
I began to love medicine again
My husband, Mark, called me at my practice. “I’ve been working on something; I need you to come home now.” He spoke definitively, urgently. “Is it the kids?” I was instinctively anxious. “No, not the kids, just come home now.”
6 p.m., a cool evening, an ordinary day. The life before the fact. And then life afterward, irrevocably and catastrophically changed.
A tense ride home, then the revelation. “I’ve been having difficulty …
Poised at the abyss: A wife faces her neurologist husband’s brain cancer
In his last state of the union address, President Obama reinvigorated the nation’s interest in a long-sidelined disease/s: cancer. A call for a moonshot was announced, and the president in his address said, “I’m putting Joe in charge of mission control.” The last time such a national commitment towards this illness was announced was by the efforts of a cancer advocate, Mary Lasker. She advocated fiercely, and the National Cancer Act …
Defending the call for a cancer moonshot
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman undergoes upper endoscopy for evaluation of dyspepsia. She has a history of pernicious anemia. She has no other medical problems and her only medication is oral vitamin B12.
On physical examination, vital signs are normal, as is the remainder of the physical examination.
Upper endoscopy discloses a 6-mm polyp in the body of the …
MKSAP: 68-year-old woman with dyspepsia
One weekend about nine-and-a-half years ago, I flew from Minneapolis, where I live, to Atlanta for a publishing conference. A colleague and I were to make a presentation to the vice-president of one of our major customers.
For a couple of weeks, I’d been plagued by a sore throat, but I’d written it off as allergies or a virus. When I tried to begin the presentation, though, all that came out …
The tears flow after chemotherapy
As an oncologist who also specializes in sexual health, I have realized just how essential it can be. I have seen many grapple with the consequences of cancer and its treatment on their own sexual view of themselves (their sexual self-schema) and how it can impact the relationship between partners. For some, the experience draws them closer; for …
Cancer’s toll on romance and sensuality
Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do.
Why do doctors over order? These same people thought a …
The question doctors should ask before ordering a test
“Do you need help getting undressed?” Jon asks from the doorway of our bedroom, one hand holding his BlackBerry, the other tucked into the front pocket of his baggy jeans. His head is slightly tilted, his eyebrows arched, highlighting his forehead wrinkles.
His phone vibrates, drawing his eyes from me to the incoming message. I wait.
Jon reads, ponders and then looks up, half-absorbed in what he’s just read, and registers that …
The first shower after surgery
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I still remember her clearly. She was a wonderfully vibrant 68-year-old woman from Haiti. She was always impeccably dressed, loved to talk, and had an incredibly infectious laugh. Whenever I walked in to the clinic to see her, her eyes always seemed to smile as broadly as she did.
“Nice to see you, Doc!” she would say. I …
We cured her, but the result was unacceptable
Young women get gynecologic cancers, and I have had my share of conversations about ovarian cancers with women in their 20s and 30s. It rarely happens, but when it does, it is devastating. I make it a point to talk with them about their present and their future; although it is something I try to do with all …
A story that showed me how cancer is a social disease
I would have graduated from medical school this year.  That’s right.  Just like you, I’d be getting ready to move to another city and take up residence at an academic medical center to begin my clinical training. Things don’t always work out the way we planned: like Lenny and George in Steinbeck’s, Of Mice and Men.  Sometimes, the best-laid plans have a way of going awry no matter how carefully we prepare them.
Cancer.  I wasn’t worried. It was …
To my fellow school of medicine graduates: Give it to them straight
Sometimes in my research on physician/patient communication, I come across a doctor who is so good with her patients, I have to share their bedside manner with you. The most recent example is a (to remain unnamed) oncologist in the northeastern United States who practically gave a primer on shared decision making when caring for a patient with metastatic cancer.
The patient (I’ll call her Jennifer Decker) had stage 4 breast …
Shared decision making: How this oncologist did it right
I am a doctor daughter. I am exhausted. My emotions are bubbling close to the surface, and I fear that at any moment, someone will do or say something to me that will cause me to lose control, which I’m not allowed to do because I’m also a female physician in a leadership role, and our emotions must be held in check.
I watched one of my mentors be memorialized last …
The story of an exhausted doctor daughter
I recognized a glitch in my electronic medical record’s decision support software when it prompted me to consider prostate and colorectal cancer screening in a 93-year-old man, who, though remarkably vigorous for his age, was unlikely to live for the additional 10 years needed to benefit from either test. Although deciding not to screen this patient was easy, determining when to stop cancer screening in older patients is often more …
How to discourage overuse of cancer screening in older adults
Medicine can wear down our hearts and souls. My journey in pediatrics has been filled with many rewarding experiences but haunting ones as well, like this one from my third year of residency. By that final year of training, I was no longer certain medicine was really the right choice for me. I was struggling with the notion that after almost 11 years of education, the destination was not quite …
This pediatrician learned why it’s so important to listen to a parent
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