As my third year of clinical rotations comes to an end, I’ve been reflecting on the ways in which I use my training as an anthropologist on the wards. One patient comes to mind, a recent immigrant from South Asia who came into the hospital after an accident where he was bicycling and got hit by a car. He was scanned from …
A background in anthropology comes in handy on the wards
The acronym “MI” has traditionally meant myocardial infarct, or heart attack. Recently it’s taken on a new, more salubrious meaning: motivational interviewing.
A growing number of docs are practicing this technique, which amounts to listening to patients to help them recognize their internal sources of behavior. Boston’s NPR affiliate, WBUR, describes typical MI interventions in which doctors, instead of demanding that patients stop smoking or drinking or overeating, gently …
How motivational interviewing can relieve patients’ suffering
Let me be clear. I have spent a career, my adult life, 80 hours a week, 131,000 hours, fighting the dread disease: every method, every drug, every machine, every medical technique, every sinew of my being, to control or cure malignancy. A synopsis of my existence will say, “fought cancer.” Nonetheless, let us take a step back, if just for a moment, and reflect on the idea of saying, “no.”
In …
Your cancer doctor can’t judge what life means to you
The Men Against Breast Cancer Fund and several cancer advocacy and physician organizations have posted a petition on Change.org asking Congress to place a two-year moratorium on finalizing the U.S. Preventive Services Task Force’s draft recommendations on screening for breast cancer to forestall the possibility that health insurers will stop covering screening mammograms for women younger than age 50. Since …
The full story on breast cancer screening. But do you want to listen?
As I previously documented in a series of posts, the road to the U.S. Preventive Service Task Force’s 2012 “don’t do it” recommendation on PSA-based screening for prostate cancer was long, arduous, and full of political pitfalls. It led to me leaving my position at the Agency for Healthcare …
A rare victory for evidence-based prostate cancer screening
We all know what the American Cancer Society, the American College of Radiology, and countless other professional societies recommend regarding screening and diagnosing breast cancer in women. But a subject that comes up far less frequently is what to do with men. While it is significantly lower than in women, a man’s risk is not nearly as low as we might …
What men need to know about breast cancer
I am in my twenties.
I am a student in dental school. My seven classmates and I have gathered, notebooks and pens in hand, for the first day of our ten-day rotation at the Veteran’s Hospital oncology department.
Dr. Steele, a published expert in oral cancer, instructs us to follow him to the outpatient clinic. Some of those he’ll examine are initial consultations; …
The ability to diagnose cancer is a necessary evil
As a practicing gynecologic oncologist, I have spoken the words, “I’m sorry, you have cancer,” or some version of that sentence thousands of times. And although my delivery is fairly consistent, modified only slightly to improve understanding, my patients’ responses vary from stunned silence to uncontrollable, overwhelming cataplexy. The stalwart emphatically reply “I’m gonna beat this thing,” but the vast majority tentatively wonder “How long do I have?” and retreat …
Cancerism and the harms of our negative cancer bias
November of last year found me living as best I could with several health issues, the most debilitating of which stems from never having recovered from a serious viral infection in 2001. I’ve been diagnosed with chronic fatigue syndrome, a little understood and much-misunderstood illness. It keeps me virtually housebound. For the most part, I’ve made peace with feeling sick all …
You can never be prepared for a diagnosis of breast cancer
Recent clinical practice guidelines from the United States Preventive Services Task Force (USPSTF) recommend against PSA screening for men of all ages, while other guideline groups, including the American Urological Association (AUA) and the American College of Physicians (ACP), recommend a shared decision making (SDM) approach to the prostate-specific antigen (PSA) test. “Dueling guidelines” can create confusion for people who are …
How a decision aid reduced men’s interest in PSA screening
I hate to be the bearer of bad news. Sorry to say, breast cancer touches everyone. If there is no one that you love that hasn’t been affected by breast cancer, just wait. It’s coming.
I have had personal experience with friends and family with breast cancer. There’s Tina, who was my roommate in medical school. There’s my mother, now a survivor for 20+ years. I have already flirted with abnormalities …
I’m waiting for the day when breast cancer will become routine
Question: What do all these cancers have in common: melanoma, lung, kidney, bladder, ovarian, head and neck, Hodgkin lymphoma, stomach, breast (and others)?
Answer: They have all shown evidence of meaningful, durable responses when treated with one or more of the new immunotherapy drugs. And that is truly amazing, not to mention very unexpected, even by the …
The fascinating journey of new immunotherapy drugs to treat cancer
Facebook is a remarkable thing. I use it for private matters — to keep in touch with family and friends from long ago. Because of it, I’ve reconnected with people from every stage of my life, as far back as third grade to high school to college and beyond. One of the …
A poignant Facebook birthday for this physician
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He sat there holding his wife’s hands and hugging her as tightly as he possibly could. Tears were streaming down her face, and she was vulnerable to the diagnosis I had just bestowed upon her. Cancer, the “C” letter word nobody wanted to hear, suddenly invaded the lives of this newly married couple.
Multiple thoughts were running through my mind before bestowing …
It is OK for the doctor to cry
I was driving to work the other day, and there was a story on the radio about the Congressional reaction to the latest recommendations for breast cancer screening from the United States Preventive Services Task Force (USPSTF).
Here’s the background. USPSTF published recommendations in late 2009 for the use of screening mammography in different age groups. For women between 40 and …
This is why it’s so hard to rein in mammogram screenings
That first time there was a moist sweet smell, the hiss of oxygen and pictures of grandchildren on the wall. Unopened juice containers, papers, a Kindle, the phone and some plastic table wear, crowded the bedside stand. Jack was thin, tired, and the tightness of his eyes spoke of uncontrolled pain.
“Oh, I know you. You took care of my wife’s friend. You’re the cancer doc.’
“Yes, that’s me, nice to meet …
The tale of Jack and Mildred: Communication in a cancer diagnosis
It’s a headline that I suspect many thought would never be written, but it was — in the New Orleans Advocate: “Harrah’s Casino in New Orleans gives patrons lollipops as it introduces smoking ban.”
Six months ago, there weren’t many who thought this could happen, that the city council of New Orleans would pass, and the mayor would sign …
What we can learn from a smoking ban in New Orleans
The harder the conflict, the more glorious the triumph. What we obtain too cheap, we esteem too lightly; it is dearness only that gives everything its value. I love the man that can smile in trouble, that can gather strength from distress and grow.
― Thomas Paine
Dear my oncologist,
This year was my 11th anniversary as a breast cancer survivor. For the past 6 …
The time I realized I kicked cancer’s ass
The patient was a young looking 74-year-old woman, accompanied by her husband. She was not exactly sure why she was seeing me and nodded as I explained that I see all women with anal or rectal cancer who are being treated with radiation therapy. I explained that we recommend that these patients use vaginal dilators to improve elasticity after …
How do you know if cancer treatment worked?
About 17 years ago, Jeff Taylor, an AIDS advocate, became worried he might have anal cancer. Through his work, Taylor knew that anal cancer rates had risen steeply among people with HIV. He was having discomfort, and he knew that there was a simple screening test: a swab that is processed just like a routine Pap smear.
His doctor knew about the …
Anal health should become a routine conversation topic between doctors and patients
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