Oncology and Hematology

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.

The human cost of breast cancer screening

Peter Ubel, MD

Conditions and Diseases

September 18, 2015

Karen Vogt’s breast cancer journey began like many others, with her breasts painfully squeezed into a mammography machine. At age 52, it was far from her first mammogram, but this scan would be the most consequential by far. It revealed microcalcifications, little areas of breast tissue speckled with deposits of calcium that her radiologist worried were suspicious for a nascent cancer, especially since these specks hadn’t been so conspicuous twelve …

What to say when medical certainty is elusive

Michael Kirsch, MD

Physician

September 15, 2015

Doctors do not know everything. We make mistakes and mistakes in judgment. Sometimes we make the mistake of speaking when we should keep silent. At times, patients ask us questions that we can’t or shouldn’t answer; and yet we do. It shouldn’t be our objective to force certainly into an issue that is amorphous and murky.

Here’s a response that I recommend in situations where certainty is elusive.

“I don’t know.”

I saw …

Treating cancer: Doing nothing is also a choice

James C. Salwitz, MD

Physician

September 14, 2015

Dear doctor:

Attached please find the medical records of Mr. Ron C., who is transferring medical care to your office. Ron is a 63-year-old gentleman with recurrent lung cancer, which has spread to his opposite lung and bones. There are multiple treatment choices for his disease, which we have discussed in detail. However, Ron is leaving my care, because he does not trust me.

As you are well aware, metastatic lung cancer …

The day I saw the humanity in medicine

Robert G. Dorfman

Medical Education

September 13, 2015

At the heart of American medicine is the concept of bedside manner, and with it the concern that doctors are cold and unemotional. Indeed, doctors are exposed to disease and misfortune on a daily basis. A patient who presents with stage IV metastatic stomach cancer is just one of the many hundreds or thousands of such patients that will walk through the hospital doors in the coming years. Quotidian exposure …

Read more…

The day I saw the humanity in medicine

Getting patients and physicians to ask the right questions

Alan R. Schroeder, MD

Physician

September 9, 2015

Overtesting — it’s an epidemic threatening consumers of U.S. health care. The notion that testing can be anything but beneficial belies the common assumption that more information is always better, as exemplified by billionaire Mark Cuban’s proclamation earlier this year that he obtains “baseline” quarterly blood tests and encourages others to do so. Knowledge is power, right? Not always. Aside from adding economic strain to our already beleaguered health care …

The heartbreak of counselling younger couples after a cancer diagnosis

Anne Katz, RN, PhD

Conditions and Diseases

September 8, 2015

My patient mix comes in waves — some months it is mostly women with breast cancer struggling with adjuvant endocrine therapy or men in the aftermath of surgery for prostate cancer. These past two months, it has been young adults, and my heart has taken a beating.

There is something quite different from my perspective between talking to a …

The public diagnosis of cancer and how President Carter did it right

Victor R. Laurion

Conditions and Diseases

September 4, 2015

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President Jimmy Carter has been diagnosed with metastatic melanoma. Recently, he gave a press conference where he discussed the history of his illness, his plans for treatment, and answered questions from the media. It was superb.

Carter, now 90 years old, demonstrated an impressive understanding of his medical circumstance. As someone who thinks and writes on patient empowerment, here are my favorite …

5 things OB/GYNs should know about treating survivors of childhood cancer

Lisa Diller, MD

Conditions and Diseases

September 3, 2015

Recent research shows improvement in long-term survival rates for childhood cancer patients, but also highlights the challenges that remain for many of the almost 400,000 survivors in the United States. Among these survivors are women facing gynecological health issues from the late effects of their treatment. What follows are several areas of concern that gynecologists and obstetricians should consider when treating women who had cancer as girls.

1. Treatment summary. …

Patient empowerment: Scaffolding has a place in health care

James C. Salwitz, MD

Physician

September 2, 2015

A colleague complained that during a particular type of critical conversation his advice is ignored. Women with breast cancer deciding whether to have mastectomies disregard his guidance and seem to have reached a conclusion before he discusses the issue. Given that this physician has committed his career to the study and treatment of breast cancer, communicates clearly and patiently, projects caring and compassion, I thought that his observation warranted discussion.

Some …

The doctor-patient relationship is even more complex than you think

Nathan A. Pennell, MD, PhD

Physician

September 2, 2015

I am often asked by friends and acquaintances how I am able to do what I do for a living, which is care for patients with advanced lung cancer. Depending on the setting and how well I know the person asking, I might say that the treatments are improving all the time (i.e., the casual dinner party response), that the …

Don’t blame yourself after a cancer diagnosis

Don S. Dizon, MD

Physician

August 26, 2015

“Why did this happen to me?”

That question is perhaps the most common one raised by patients facing a diagnosis of cancer for the first time. There are so many campaigns about how to “avoid” cancer: no white sugar, no chemicals, all-plant diets, regular exercise, don’t smoke, don’t drink. I can see how one can get the impression that if …

Patients become people through the social history

Merry Jennifer Markham, MD

Physician

August 26, 2015

One day in clinic, recently, I reviewed my daily schedule with the oncology fellows who were working with me that day. With the exception of the new patients on my schedule, I recognized all of the names on my list. I opened the electronic chart of the first patient to skim the problem list, a handy spot where I …

Maybe health costs should be a quality measure

James C. Salwitz, MD

Conditions and Diseases

August 25, 2015

How do we measure a doctor? Hospital length of stay? Infection rate? Flu shot compliance? Waiting time? These reality surrogates do not tell us how a patient feels or the quality of life. They are complex to measure, require major data crunching and may not focus on an individual physician. This week, two patients reminded me of a basic screening tool for …

Spending time with patients. That’s my job.

Nathan A. Pennell, MD, PhD

Physician

August 18, 2015

I’m sure I am not alone in saying that I am almost obsessively conscious of time. Namely, that there never seems to be enough of it. As busy oncologists, we all have constant demands on our time, from our leadership, colleagues, drug company reps, insurers, and our families, not to mention the time we try to carve out for ourselves. But …

This is great medical care. With a large helping of unnecessary suffering.

Val Jones, MD

Physician

August 17, 2015

I watched helplessly as a dear friend went through the emotional meat grinder of a new cancer diagnosis. Her husband was found to have melanoma on a recent skin biopsy, and she knew that this was a dangerous disease. Because she is exceptionally intelligent and diligent, she set out to optimize his outcome with good information and the best care possible. Without much help from me, she located the finest …

Is there a place for alternative therapy in cancer treatment?

Don S. Dizon, MD

Medications

August 9, 2015

I vividly remember meeting her, despite all the years that had passed. At 6 feet tall she towered over me (granted, anyone who has met me will know that’s not hard to imagine) and yes, I’ll admit it — she had physically intimidated me. But about 10 minutes into the initial consultation, I realized she was soft-spoken, kind, and, …

Children with cancer are the real superheroes

Steve Christiansen, MD

Physician

August 6, 2015

Recently I met a boy, a boy with leukemia, a young boy with comic-book worthy superpowers. This boy, this superhero, is one I will never, never forget.

When I entered the exam room, I was immediately struck by the sight of a young boy who should have been playing football with his friends at the park or jumping off the high-dive at the pool, but instead …

This is what it’s like to face recurrent cancer while going broke

Holly Davis

Patient

August 4, 2015

I am one of many people today “living” with cancer. I want to focus on the impact cancer has on my personal finances, and this is probably true for any chronic illness, not just cancer.

First, you often have to give up your job. While undergoing chemo, most of us don’t have the energy for a full time job. And if you do …

A father keeps his cancer secret from his daughter. The reason will break your heart.

James C. Salwitz, MD

Physician

August 4, 2015

Norman cried the night his daughter was born. For hours and hours. Each time he looked at her perfect head, touched the few strands of blond hair, held her in his arms, soft, smooth skin, soapy smell, pale blue eyes, tears poured down his cheeks. He felt alive. He felt alone. They named her Matilda, after his father. It was the right thing to do, because his father, Matthew, had …

A mother with terminal brain cancer. Her daughter brings her home.

Jessica Vogelsang, DVM

Physician

August 1, 2015

I found out my mother was dying via text message: YOUR MOM HAS A BRAIN TUMOR IN HOSPITAL — DAD

When the neurosurgery PA wheeled the computer into the exam room to show us the MRI the next morning, I found myself silently uttering an unanswered prayer that the mass would be small, resectable, peripheral. It wasn’t.

“Oh my God,” Mom whispered. “I’m going to …