Oncology and hematology

2,498 articles · Since 2004

Articles, page 54

The death certificate didn’t say enough

September 17, 2014Sep 17, 201413

August 17, 2010. Maris is a 57-year-old woman in excellent health. She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law. A successful businesswoman, Maris gardens, serves on…

August 17, 2010. Maris is a 57-year-old woman in excellent health. She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law. A successful businesswoman, Maris gardens, serves on the board of a community theater and plays a mean game of bridge.

It is 10:11 a.m. when Maris presents to the emergency room. Three hours earlier, her legs became wobbly while …

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The death certificate didn’t say enough

Conditions and diseases

Sex or death: The difficult decisions of prostate cancer treatment

Anne Katz, RN, PhD

September 12, 2014Sep 12, 201415

As part of my role as a clinical nurse specialist in a busy prostate clinic, I see men (with their partner) as part of their decision-making process for active treatment for prostate cancer. The purpose of the appointment is for…

Physician voices

What’s it like to be an oncologist? This is just one day.

James C. Salwitz, MD

September 10, 2014Sep 10, 20143

7:00 a.m. Lights on. Coffee, black and a banana. Paperwork. 27 patient visits, 3 emergencies, 35 phone calls. Lots of computer time. Some laughs and a few tears. Paperwork. Last family meeting. Coffee, black. In between: Thursday. Was not completely…

7:00 a.m. Lights on.

Coffee, black and a banana. Paperwork. 27 patient visits, 3 emergencies, 35 phone calls. Lots of computer time. Some laughs and a few tears. Paperwork. Last family meeting. Coffee, black. In between: Thursday.

Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range …

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Conditions and diseases

A physician is now biased towards over-testing. Here’s why.

Val Jones, MD

September 5, 2014Sep 5, 20147

Health screening is part of good preventive care, though over-screening can lead to increased costs, and potential patient harm. Health care professional societies have recently developed excellent public service announcements describing the dangers of over-testing, and new research suggests that though additional medical interventions are associated with increased patient satisfaction, they also lead (ironically) to higher mortality rates.

And so, in a system attempting to shift to a “less is more” …

Physician voices

Does owning cancer equipment change treatment patterns?

Robert Pearl, MD

September 4, 2014Sep 4, 201425

Today’s article follows the money trail to expose a different form of bias: the kind that takes place when doctors own their own diagnostic and therapeutic equipment. For people living with cancer, this kind of bias can have a particularly…

Today’s article follows the money trail to expose a different form of bias: the kind that takes place when doctors own their own diagnostic and therapeutic equipment.

For people living with cancer, this kind of bias can have a particularly painful impact.

Radiation therapy brings out medical bias

In the United States, cancer is the second most common cause of death, killing nearly 600,000 Americans …

Physician voices

A bystander to the evolution of plastic surgery

Miranda Fielding, MD

September 2, 2014Sep 2, 201411

I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights. The show stars Clive Owen as the charismatic cocaine-addicted chief of surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop. The tagline is as they say, priceless: “Modern medicine had to start somewhere.”

On the third episode, last Friday …

Conditions and diseases

Cancer screening in the elderly: Don’t be stupid

Kenneth Lin, MD

September 1, 2014Sep 1, 20146

The electronic medical record that my office uses features a clinical protocol button that we are encouraged to click during patient visits to remind us about potentially indicated preventive services, such as obesity and tobacco counseling and cancer screenings. I once tried it out while seeing a 90-year-old with four chronic health problems. The computer suggested breast cancer, colorectal cancer, and cervical cancer screenings: three totally inappropriate tests for the …

Physician voices

My new practice saves lives

Rob Lamberts, MD

August 26, 2014Aug 26, 201416

Oh yeah. Hot dang. All right. Groovy. Boom goes the dynamite. I had a very great day yesterday. I saw three patients who had recent diagnoses of cancer. Yeah, those two statements seem to contradict. They don't. Each person I…

Oh yeah. Hot dang. All right. Groovy.

Boom goes the dynamite.

I had a very great day yesterday.

I saw three patients who had recent diagnoses of cancer. Yeah, those two statements seem to contradict. They don’t. Each person I saw gave me a clear view of how the practice I’ve been building over the past 18 months is making a difference. A big, big difference.

The first patient was a guy who is …

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My new practice saves lives

Physician voices

Delivering bad news: Don’t pass the buck

Don S. Dizon, MD

August 22, 2014Aug 22, 20146

When I was a fellow, part of our training involved doing consults for patients, most of whom had just learned they had cancer or recurrence of disease. These consults were never easy, but the importance of sitting with someone who had just learned of their diagnosis was an integral part of learning the medicine and art of oncology.

Even after many …

Conditions and diseases

Missed opportunities give leverage to cancer

Kenneth D. Bishop, MD, PhD

August 21, 2014Aug 21, 2014

Last week a patient said to me, "You live your whole life thinking you're going to have time to enjoy life later on, and then this happens." Then he started to cry because we had just reviewed his recent CT…

Last week a patient said to me, “You live your whole life thinking you’re going to have time to enjoy life later on, and then this happens.” Then he started to cry because we had just reviewed his recent CT scans and some of his lab results and he had a new diagnosis of a type and stage of cancer that meant he likely had about eight months to live. …

Physician voices

How we cope with a cancer diagnosis starts in childhood

James C. Salwitz, MD

August 21, 2014Aug 21, 20142

A baby’s smile reflects the purity in their heart. An infant’s world is a marvelous place of possibility and love. Children see themselves as special, capable, even omnipotent. Time teaches failure, loss, and mortality. How much we lose of that original perfection, that first excitement, that natural confidence, determines how we face the challenges and tragedies of life; whether we will be happy. It may even determine how we cope …

Physician voices

Oncologist pay and chemotherapy: Buy and bill needs to stop

Robert Pearl, MD

August 19, 2014Aug 19, 201437

Today’s article highlights the lingering problem of physicians buying and selling prescription medications to patients -- at a profit. The medical profession has struggled with this controversial practice for more than 150 years. In George Eliot’s 1874 novel “Middlemarch,” an…

Today’s article highlights the lingering problem of physicians buying and selling prescription medications to patients — at a profit.

The medical profession has struggled with this controversial practice for more than 150 years.

In George Eliot’s 1874 novel “Middlemarch,” an idealistic young doctor named Tertius Lydgate questions the ethics of fellow physicians who make handsome profits prescribing and dispensing their own remedies to the townsfolk. His medical colleagues shun him for it.

Around …

Physician voices

I am so sorry I didn’t make this different for you

Merry Jennifer Markham, MD

August 9, 2014Aug 9, 20142

The telephone message arrived in my EMR’s inbox. A patient’s daughter had called and wanted to ask some questions about her mother. Her mother, Louise (name changed), had died about two weeks before. I hesitated before calling her, recalling her…

I hesitated before calling her, recalling her mother’s cancer course.

Louise had been diagnosed with cancer at a relatively young age, in her late 40s. She received curative chemotherapy …

Conditions and diseases

Cutting the wrong test at the wrong time

Colleen M. Schmitt, MD & Harry E. Sarles Jr., MD & John I. Allen, MD, MBA

August 8, 2014Aug 8, 2014

At the critical time when our nation has made meaningful and measurable progress against colorectal cancer incidence, threats to reimbursement for colonoscopy screening for Medicare beneficiaries are looming, which may jeopardize the effectiveness of public health strategies to increase screening…

New data from the American Cancer Society indicate that colorectal cancer has declined by 30% in just the last decade among those aged 50 …

Conditions and diseases

Today it’s time to say, “Ultraviolet bad”

J. Leonard Lichtenfeld, MD

August 6, 2014Aug 6, 2014

“Ultraviolet bad.” That was the core message that came out of the introduction this morning of the Surgeon General’s Call to Action to Prevent Skin Cancer at a meeting held at the National Press Club in Washington DC. There were…

“Ultraviolet bad.”

That was the core message that came out of the introduction this morning of the Surgeon General’s Call to Action to Prevent Skin Cancer at a meeting held at the National Press Club in Washington DC.

There were some other messages that now raise skin cancer awareness and prevention high on the public health awareness list, such as …

Physician voices

Giving terrible news to those we love

James C. Salwitz, MD

August 5, 2014Aug 5, 20143

I knew immediately it was a problem. It was not just that Faith’s cancer had spread with innumerable masses in her liver, golf ball-like tumors in her lungs, punched out holes in her bones. It was not that the chemo, third round and toxic, had failed. Those were awful things. Rather it was her response as I began to tell her. As soon as I said, “I looked at the …

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Giving terrible news to those we love

Conditions and diseases

5 things internists should know about treating survivors of childhood cancer

Lisa Diller, MD

August 4, 2014Aug 4, 2014

Recent research finds that many internists do not feel comfortable or prepared to care for survivors of childhood cancer. Although the rarity of childhood cancer may explain this, the fact remains that as more and more pediatric cancer patients survive into adulthood busy internists often have some survivors in their practices. These patients would have been treated during the last decades of the 20th century or the beginning of …

Physician voices

The $16.7 million x-ray: Possible beats probable in court

Dr. Saurabh Jha

August 3, 2014Aug 3, 20145

In a recent verdict a jury in Massachusetts awarded $16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47, for a missed cancer on a chest x-ray. The verdict reminds one of…

In a recent verdict a jury in Massachusetts awarded $16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47, for a missed cancer on a chest x-ray.

The verdict reminds one of the words of John Bradford, the heretic, who was burnt at the stakes. “There but for the grace of God go I.”

Many radiologists will sympathize with both the patient who …

Conditions and diseases

Are vasectomies a risk factor for prostate cancer?

Rajiv Singal, MD

August 2, 2014Aug 2, 2014

Recently, I realized that patients coming to my office seeking vasectomies required an additional piece in their counseling. What led to this change? Earlier this month a study out of Harvard University suggested an association between vasectomy and lethal prostate cancer. Published in the Journal of Clinical Oncology, the researchers found that “men with a history of vasectomy had a 10% increased risk of prostate cancer, …

Physician voices

Law and medicine are more intertwined than they should be

Michael Kirsch, MD

August 1, 2014Aug 1, 20144

I’m a law abiding blogger. Laws are meant to be obeyed. If an individual opposes a law in a free country, then he should operate within the system to modify it. I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform.

I’m not suggesting that an unwelcome …

Oncology and hematology

Articles, page 54

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