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.

Pathologists welcome the opportunity for more direct patient care

Michael Misialek, MD

Physician

August 21, 2013

“How much time do I have?” was the first question Mrs. C asked.

She had called me in a panic. Earlier in the week, I had diagnosed her with breast cancer. She called me after learning the bad news from her radiologist. A whirlwind of appointments with oncology, surgery, and radiation oncology ensued, overwhelming her with information.

I knew her case — these cells and her pathology — well, having just presented …

How fear affects cancer survivorship

Jessie Gruman, PhD

Patient

August 20, 2013

A recent Wall Street Journal article about how post-traumatic stress syndrome can be caused by cancer and stroke brought to mind the variety of responses many people experience in response to cancer diagnosis and treatment. The lingering intensity of those responses – physical, psychological, social and behavioral – can affect whether and how we attend to the tasks of survivorship; that is, monitoring and addressing the unique health challenges that follow treatment …

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How fear affects cancer survivorship

The complicated existential dilemma of living with cancer

Don S. Dizon, MD

Physician

August 20, 2013

Maybe I should’ve noticed how she looked. “She” was a new patient, Louise*, and she had been diagnosed with stage IV cervical cancer. Only in her 40s, the diagnosis had hit her extremely hard. At her first meeting, she wanted the “truth,” and I had told her what I felt to be most relevant — that her cancer had spread, that …

When donated blood is wasted

James C. Salwitz, MD

Physician

August 19, 2013

This week my toughest case involved futile care. We admitted a patient with very advanced cancer, dying naturally at home on hospice. Because of last minute family intervention, the patient ended up spending 48 hours on super-max support, dying quite horribly with tubes and lines in every natural and unnatural orifice. Liver failure, lung failure, kidney failure, bleeding, blood clots and …

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When donated blood is wasted

Why you should consider a second opinion from a pathologist

Roger Reichert, MD, PhD

Conditions and Diseases

August 17, 2013

Patients are becoming more and more adept at taking control of their own health care, and this often involves seeking a second opinion of their presumptive diagnosis. However, in far too many cases in which cancer or precancerous conditions are diagnosed, the consultation is at the level of another treating physician, without confirmation that the patient’s pathologic diagnosis is correct. In cases where clinical management decisions and prognosis hinge on …

When surgeons and patients don’t tolerate ambiguity very well

Bruce Campbell, MD

Physician

August 14, 2013

Do not now look for the answers … At present you need to live the question. Perhaps you will gradually, without even noticing it, find yourself experiencing the answer.
-Rainer Maria Rilke

Two men, Ted and Ron, were long-term professional colleagues. I do not believe that they were particularly close, but they had been acquainted during their working lives. Each had retired.

In what was a remarkable coincidence, both men were diagnosed with …

Make the difficult journey of cancer patients a bit easier

J. Leonard Lichtenfeld, MD

Conditions and Diseases

August 14, 2013

A newspaper story recently caught my eye when it headlined: “Senators Revive Push for End-of-Life-Care Planning.” It reported on new legislation making the rounds in Washington to address care planning for those with advanced illnesses.

You remember “end of life care planning,” don’t you? It was part of the Affordable Care Act debate several years ago, and quickly became translated into Read more…

Make the difficult journey of cancer patients a bit easier

Inspiring a new generation of oncologists

Don S. Dizon, MD

Medical Education

August 13, 2013

One of the things I enjoy as an academic oncologist is the opportunity to teach. I like having students, residents, and fellows in my clinic and the opportunity for them to see what oncology is and what we do; how we “marry” the art and science of medicine in our routine care of patients with cancer.

For several years, I’ve co-directed an …

Fish oil and prostate cancer: Go beyond the headlines

David L. Katz, MD

Conditions and Diseases

August 12, 2013

I suppose it may help diffuse any relevant tensions to get the punch line out of the way: I have a prostate, and in the context of my mostly-plant diet, will continue to eat fish and take a daily omega-3 supplement (krill oil in my case). We will, as well, continue using various omega-3 supplements in varying doses for specific therapeutic purposes in my clinic.

And now, let’s turn to the …

The very best physicians do not judge their patients

James C. Salwitz, MD

Physician

August 10, 2013

It occurs to me there are several keys to being an excellent physician. One must love science, enjoy hard work, have the courage to make tough decisions, carry a modicum of intelligence and suffer angst at receiving 94% on an organic chemistry test. In addition, the very best physicians, those we admire and to whom we flock, have a secret weapon. They do not care.

I do not mean that they …

MKSAP: 58-year old woman with fatigue and weight loss

mksap

Conditions and Diseases

August 10, 2013

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

A 58-year old woman is evaluated for a 3-week history of fatigue and weight loss. The patient has no significant medical history and takes no prescription medication, but she does take a daily over-the-counter multivitamin and a calcium supplement. She has a 50-pack-year smoking history.

Physical examination reveals a lethargic, ill-appearing woman. Temperature is 37.3 …

Can prayer heal the sick?

Michael Kirsch, MD

Physician

August 8, 2013

Faith and reason entered my medical universe recently.

A patient underwent surgery to resect a colon cancer. The tumor had metastasized to the lymph nodes, an unfavorable prognostic event. The surgeon entered the room and advised the patient that her survival is likely limited to 1-2 years. The patient and her husband were devastated. The distraught husband spent the next 24 hours sobbing in a painful and despondent state. He related …

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Can prayer heal the sick?

Good doctors are those who genuinely care about patients

Robert Spencer, MD

Patient

August 7, 2013

Helpless. That is how I felt when my mother found out she had a fibroid the size of a cantaloupe living in her uterus. In my role as a medical student I might have dismissed the finding as nothing serious, telling my patient, “Don’t worry, it could be much worse.” But as a loving son I was not quite as cavalier. At first my mother resolved to ignore the fibroid, …

Do you worry about the diseases you learn in medical school?

Hans Duvefelt, MD

Conditions and Diseases

August 7, 2013

It was spring. My medical school class, two years along in our five-and-a-half year endeavor, had earned the “medicinae kandidat” degree. We were now worthy of leaving the basic sciences and research center on the outskirts of town and starting our preparatory clinical, “propedeutic” semester at the University Hospital. In Sweden, at that time, we used a lot of Latin words and phrases. Crohn’s disease was Morbus Crohn, chart notes …

E-cigarettes: Are they effective? Are they safe?

Deep Ramachandran, MD

Medications

August 7, 2013

Electronic cigarettes are here, settling over the country, quite literally, like a fine white fog. Smokers in turn, have been turning to them as a tool to help them quit, though the device manufacturers are not allowed to market them that way in U.S. It seems intuitive that a device that mimics the action of smoking but without the combustion and …

You may not remember me, but you changed me

Ilana Yurkiewicz

Medical Education

August 7, 2013

You may not remember me, but when I asked how you were, you said, “alive.”

A few weeks earlier you were afraid of going under anesthesia and not waking up. They said you’d do great; that this was routine; that we’d see you again soon. Then you coded on the table. I’ve never met someone who was grateful for life the way you expressed to me that day.

You may not remember …

Melanoma refuses to abide the laws of general civilization

Samyukta Mullangi

Conditions and Diseases

August 6, 2013

The man who had been seated in room 2 by the medical assistant had been seen 6 months previously for a small, pigmented lesion behind his left ear, which a punch biopsy subsequently proved to be malignant melanoma in situ. He was sent to the Mohs surgeon in the interim who carefully excised just as much skin as was absolutely necessary and …

Exercise is a powerful tool in the fight against cancer

James C. Salwitz, MD

Conditions and Diseases

August 1, 2013

If you had cancer, how good would a treatment have to be, how much would it have to help, for you to use it? How about if it gave you a 5% better chance of cure? A 10% chance? How about a 20% chance to be beat the disease using a treatment without side effects that is free? “Sign me up,” you say? Nonetheless, only 8% of breast cancer patients …

Lessons learned from a family meeting

Don S. Dizon, MD

Physician

July 29, 2013

Recently, my family experienced the loss of someone very dear- Uncle Peter. Peter was an ex-Marine, father of three men, and patriarch of my spouse’s family; not to mention, husband to my wonderful and artistic Aunt Helene. He had been admitted to an outside hospital with leg ischemia and was transferred to a tertiary facility. Unfortunately, things did not turn out …

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Lessons learned from a family meeting

The unwritten contract: Cancer cannot be beaten any other way

James C. Salwitz, MD

Physician

July 27, 2013

I had a patient this week that really screwed up his medical care when he experienced a predicted side effect of curative chemotherapy. Despite clear instructions and access to every number my partners, my staff and I have, including office, triage, cell, and answering service, he did not reach out. Day-by-day he lay in bed, as he grew weaker and multiple systems failed. No one contacted me. Finally, he sent …

Oncology and Hematology

Oncology and Hematology

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