Oncology and hematology

2,498 articles · Since 2004

Articles, page 58

When insurers dictate medical decisions

March 25, 2014Mar 25, 201414

Have you ever had a conversation that rattles around in your head for days? Maybe, it changed what you thought you knew about the world. Perhaps the ideas or comments did not make any sense. I had a discussion last week and it seemed that logic stood on its head. The means was defined by the end, with no connection to the beginning, or more exactly, the tail wagged the …

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When insurers dictate medical decisions

Physician voices

Perverse incentives push physicians to order ineffective tests

Albert Fuchs, MD

March 21, 2014Mar 21, 201420

When I meet a new patient, I’m frequently astounded by the health care he has received. I’ve met patients with absolutely no cardiac symptoms who have been receiving EKGs every six months for years. I’ve had patients brag to me about their annual executive physicals in which myriad tests including treadmill stress tests and chest x-rays were routinely performed. Patients get head-to-toe CT scans under the mistaken hope that they …

Conditions and diseases

Young patients with adenomas: Who should get genetic testing?

Patrick M. Lynch, MD

March 20, 2014Mar 20, 2014

While it is unusual for gastroenterologists to see colorectal tumors in patients under the age of 50, and even more uncommon before the age of 40, it does happen, so patients need to be aware of their risks. Colorectal tumors in young people are often detected either through symptom evaluation or because of a colonoscopy performed for an underlying risk factor, most commonly a family history of colorectal cancer (CRC).

During …

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Physician voices

Radiologists aren’t the only ones criticizing the new mammogram study

Geraldine McGinty, MD, MBA

March 15, 2014Mar 15, 20146

Supporters of the most recent paper from the Canadian National Breast Screening Study (CNBSS) falsely contend that only radiologists are criticizing this study. This simply is not true. The Canadian study flaws have been well documented for decades. Robert E.…

Robert E. Tarone at the National Cancer Institute (who isn’t a radiologist) wrote in 1995 that there was a statistically significant excess of advanced cancers that were allocated to the mammography …

Patient voices

Residual fear after a cancer diagnosis

Jackie Fox

March 14, 2014Mar 14, 20142

I went to see my oncologist for my six-month checkup yesterday. All was routine, other than my blood pressure being 131 over something when it's usually in the 115 range, even when I see my family doctor. No anxiety there.…

I went to see my oncologist for my six-month checkup yesterday. All was routine, other than my blood pressure being 131 over something when it’s usually in the 115 range, even when I see my family doctor. No anxiety there.

When he asked what had changed in the last six months, I told him about the endoscopy I had in December, which turned out to be normal. But what prompted it …

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Residual fear after a cancer diagnosis

Physician voices

When patients ignore the evidence: Try to understand their values

Don S. Dizon, MD

March 13, 2014Mar 13, 201418

I still remember being taken aback by how young she was. “She” was Mary -- a 28-year-old woman who had completed chemotherapy for stage II breast cancer. She was treated elsewhere and had moved cities when her husband got a…

I still remember being taken aback by how young she was. “She” was Mary — a 28-year-old woman who had completed chemotherapy for stage II breast cancer. She was treated elsewhere and had moved cities when her husband got a promotion.

“I’m still getting used to this area, but I am happy my hair came back before we had to move. I …

Conditions and diseases

Watchful waiting for prostate cancer: Implications of a new study

J. Leonard Lichtenfeld, MD

March 13, 2014Mar 13, 20143

News reports covering a prostate cancer study recently in the New England Journal of Medicine have all pretty much come out with the same message: men diagnosed with prostate cancer who had radical surgery did much better than men who…

News reports covering a prostate cancer study recently in the New England Journal of Medicine have all pretty much come out with the same message: men diagnosed with prostate cancer who had radical surgery did much better than men who were assigned to “watchful waiting” after they were diagnosed.

But guess what? There’s a critical fact that seemed to be missing in much of the coverage I saw. And that fact …

Physician voices

How much will it cost to die?

JaBaris Swain, MD, MPH

March 12, 2014Mar 12, 20143

It was probably the most awkward question I had been asked before, and I did not have an answer. He was a middle-aged gentleman, neatly dressed -- very simple and unassuming. He blended like a lifeless statue in the waiting…

It was probably the most awkward question I had been asked before, and I did not have an answer.

He was a middle-aged gentleman, neatly dressed — very simple and unassuming. He blended like a lifeless statue in the waiting area. What sparked my notice of him was his accompanying robust file, crammed with familiar pink discharge slips from the ED. He was clearly what we call a “frequent flyer,” but …

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How much will it cost to die?

Physician voices

Sympathy is the missing art in medicine

Bashar Ismail

March 8, 2014Mar 8, 20145

I still remember when my phone rang with an eerie sound, early in December 2013. The oncologist I had seen a couple of days earlier was on the other end asking me to return to the hospital ASAP because my bone marrow biopsy results was consistent with acute leukemia and I was at risk of bleeding.

That was the first time I knew about my diagnosis while he merely broke the …

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Sympathy is the missing art in medicine

Conditions and diseases

MKSAP: 43-year-old man with severe abdominal pain

mksap

March 8, 2014Mar 8, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 43-year-old man is evaluated in the hospital for severe abdominal pain of 2 days' duration. He is otherwise healthy except for the recent…

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

A 43-year-old man is evaluated in the hospital for severe abdominal pain of 2 days’ duration. He is otherwise healthy except for the recent finding of pancytopenia. Family history is noncontributory. His only medication is a daily multivitamin. Following a physical exam and lab results, what test is most likely to establish …

Physician voices

A perfect day in the cancer clinic

James C. Salwitz, MD

March 6, 2014Mar 6, 2014

It happens, now and then; not as often as one would wish, but occasionally. In other professions, a perfect day is when you make that super sale, finish a protracted project, win an important race or craft a special, remarkable piece of art. An oncology perfect day can be without bells, whistles, pats on the back, nor cash register’s whirr. Some of the best days lack pizzazz, vibrant emotion or …

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A perfect day in the cancer clinic

Physician voices

We will be waiting for something until the day we die

Greg Smith, MD

March 6, 2014Mar 6, 2014

We’re all waiting for something. As kids, we waited for the time that we could do it ourselves, go it alone, tie our own shoelaces, order our own food off the menu, take our baths by ourselves, and walk up…

We’re all waiting for something.

As kids, we waited for the time that we could do it ourselves, go it alone, tie our own shoelaces, order our own food off the menu, take our baths by ourselves, and walk up and down the street or around the mall without parental supervision. We were kids. We didn’t yet have enough life experience or enough insight to realize that the time we occupied, …

Conditions and diseases

The costs of care was far beyond her means

Monica Williams-Murphy, MD

March 5, 2014Mar 5, 201427

Mrs. Sandra Jackson knew that she was no Warren Buffet. She knew that she was no Bill Gates. Instead, Mrs. Jackson knew that she worked two jobs, 7 days a week to support her family. So, she hid her breast condition for a better time, another day. She would ask herself, which was more important: going to a doctor or buying her children dinner? For a true mother, the answer …

Conditions and diseases

The benefits of screening mammography have been greatly exaggerated

Charles Wright, MD

March 4, 2014Mar 4, 201441

When first introduced four decades ago, breast cancer screening with mammography was widely regarded as an important tool in the fight against this terrible disease. It seemed obvious that the earlier it could be diagnosed the more lives could be saved. Aggressive treatment, it was thought, would prevent the cancer from spreading through the body. A huge amount of research evidence since then has slowly and painfully led to a …

Conditions and diseases

Get rid of the cancer first before considering breast reconstruction

Miranda Fielding, MD

March 2, 2014Mar 2, 20147

When it comes to surgery for cancer, having a “positive margin” is a bad thing. It means that when the surgeon said he “got it all,” even though he meant it with all of his heart, likely he didn’t. For a woman undergoing a lumpectomy for breast cancer, that positive margin means a re-excision of the lumpectomy site or alternatively, a mastectomy. For a woman who has just had a …

Conditions and diseases

The conspiracy of cancer prognosis

Rick Boulay, MD

March 1, 2014Mar 1, 20143

It should be easy, right? I mean, I am a professional with what feels like eons of training. So how can an oncologist with years of experience fail at perhaps the most important question a patient can ask, ”How long…

It’s not that I want to avoid the question. Well, okay, sometimes I do. It’s not the most pleasant of conversations to have. But really, I don’t …

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The conspiracy of cancer prognosis

Conditions and diseases

How we doubled colorectal cancer screening rates

Theodore R. Levin, MD

March 1, 2014Mar 1, 2014

March is colorectal cancer (CRC) awareness month, so it’s an appropriate time to reflect on how to increase the number of people who get screened for this cancer that’s largely preventable through screening. Between 2005 and 2012, Kaiser Permanente, Northern…

So how did we do it?

We employ a combined screening model with fecal immunochemical test (FIT) outreach and …

Patient voices

From a mother: What my child’s oncologist should know

Suzanne Leigh

February 28, 2014Feb 28, 201455

Please let us know that we’re not alone. We realize that our doctors are not our friends, but telling us that the medical team will be sticking with us during this journey that we were never on board with, is…

Please let us know that we’re not alone. We realize that our doctors are not our friends, but telling us that the medical team will be sticking with us during this journey that we were never on board with, is an empowering message when we are at our most powerless.

Show us that you care about our child, too. We know that you identify our …

Patient voices

Chronic conditions don’t have normal business hours

Jessie Gruman, PhD

February 27, 2014Feb 27, 20142

It looks like an airport lounge without the rolling suitcases. There are about 20 of us cancer survivor-types fiddling with our phones or reading the newspaper. A few of us are sipping delicious contrast fluid in preparation for a scan, but most of us are waiting to meet with our oncologists for follow-up or monitoring visits. All of us are between the ages of 20 and 70 and all of …

Conditions and diseases

To every cancer patient: You give us courage

James C. Salwitz, MD

February 27, 2014Feb 27, 20142

Hot oil splatters as thick fatty fish slips into the smoking pan, next to boiling rice and simmering garlic greens. Quickly golden, she flips the fillet and turns down the heat. Small feet pound down the stairs, drawn by the crackling aroma, but it’s a mother’s trap; she motions the child to set the table. One by one, the family gathers, as plates and utensils clatter onto the wood and …

Oncology and hematology

Articles, page 58

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