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.

Should you choose to have a robotic hysterectomy?

Jennifer Gunter, MD

Conditions and Diseases

May 20, 2013

In a word, no (unless you have cancer). So, let’s take cancer out of the picture and discuss hysterectomy for non-cancerous (benign) reasons.

First of all. A hysterectomy (removing the uterus) can be done via one of the 4 methods:

1. Vaginal, a small incision at the top of the vagina and the uterus is removed entirely through the vagina without any incision on the abdomen.

2. Laparoscopic surgery, where incisions are made …

Medical mistakes occurred at all levels of my care

Itzhak Brook, MD

Physician

May 18, 2013

Medical and surgical errors are very common in the hospital setting. They increase malpractice lawsuits, the cost of medical care, patients’ hospital stays, and morbidity and mortality. As an infectious diseases specialist for over forty years, I was not aware how common these errors are until I became a patient myself after being diagnosed with hypopharyngeal carcinoma. My initial cancer was successfully removed, but a local recurrence occurred twenty months …

Living with an illness for which there is no cure

Ellen Diamond

Patient

May 17, 2013

For the past fifteen years, I have had an incurable form of leukemia.

Such diseases used to be called terminal illnesses, but we don’t hear that term as much anymore. With all the new drugs and treatments available, doctors have become more reluctant to refer to diseases they can’t cure yet as “terminal.”

In the years just after my diagnosis, when friends and family would ask what could be done for it, …

Being a caregiver has made me a better doctor

Scott Finkelstein, MD

Physician

May 17, 2013

I am a physician, an anesthesiologist. I care for the sickest of the sick every day – struggling NICU babies born only hours earlier, victims of major traumatic accidents, and critically ill patients with life threatening illness. In this job, I must both connect with the patient, but also maintain a distance from them at the same time. Dealing with life threatening …

Measuring patient engagement: What would Ken Schwartz think?

Pat Mastors

Patient

May 17, 2013

Don’t get me wrong, it’s huge to see patient safety evolving to be a front-burner issue. After beating the drum for years, the National Patient Safety Foundation and other groups are seeing progress, with meaningful use, electronic health records, pay for performance, and the patient-centered medical home.

Medicare innovation grants and the Partnership for Patients are chipping away at medical harm and 30 day readmissions. Empowered patients are test-driving their choices …

Stories surround every physician

Bruce Campbell, MD

Physician

May 17, 2013

Could a greater miracle take place than for us to look through each other’s eyes for an instant?
-Henry David Thoreau

It is almost 7:00am I carry my briefcase and lunch bag from the car to my office. I nod to some of the night shift employees heading home. Another day has begun.

I type my password and check the computer, reminding myself of the twenty patients I am scheduled to see today …

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Stories surround every physician

Skin cancer does not discriminate

Adam Friedman, MD

Conditions and Diseases

May 15, 2013

Melanoma

For people of color, skin cancer may not be top of mind as a significant health threat. But as I tell my patients in the multi-cultural borough of the Bronx, NY, skin cancer does not discriminate and it impacts all populations regardless of color.

While somewhat rarer in skin of color, skin cancers, including potentially deadly melanoma, do occur and can be quite …

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Skin cancer does not discriminate

How one urologist approaches PSA testing

Neil Baum, MD

Conditions and Diseases

May 12, 2013

Prostate cancer is the most commonly diagnosed non–skin cancer among U.S. men. It can be life-threatening, and many men have cancer without knowing it. For those reasons, doctors sometimes look for prostate cancer in healthy men (screen for cancer) by measuring blood levels of prostate-specific antigen (PSA), a protein secreted by the prostate gland. High PSA levels can be caused by cancer and may lead a doctor to take a …

A radiologist reflects on indeterminate findings

Paul Dorio, MD

Physician

May 7, 2013

Radiologists care about their patients, even though most diagnostic radiologists don’t meet and greet their patients the same way direct-care clinicians do.

Some people have the erroneous perspective that radiologists and pathologists don’t care about the welfare of their patients. It is possible for us to understand that view if we look at radiologists and pathologists as isolated workers who work …

ACCP: Updated lung cancer guidelines

W. Michael Alberts, MD and Frank Detterbeck, MD

Conditions and Diseases

May 7, 2013

Lung cancer causes more deaths in the United States, 160,000 estimated in 2012, than the next three most common cancers, colon, breast, and prostate, combined.

More than 1.6 million people worldwide were newly diagnosed with lung cancer, comprising 13% of all new cancer diagnoses, and 1.4 million died of lung cancer, which was 18% of all …

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ACCP: Updated lung cancer guidelines

When alternative cancer therapy harms patients

James C. Salwitz, MD

Medications

May 6, 2013

After a terribly painful and debilitating illness, Steve died. He had been treated for Stage 2 Hodgkin’s Disease with a series of intense therapies including German enzymes, American antineoplastins, Mexican naturopathy and Chinese herbs, complemented by focused meditation, innumerable vitamins, extreme diet modification and acupuncture for severe pain. He fought the cancer with every ounce of his being, doing everything to survive, except the one thing that had an 85% …

When it comes to handling cases, good communication helps

Gizabeth Shyder, MD

Physician

May 5, 2013

I saw a thoracic surgeon in the doctor’s lounge today. I have read his cases and frozens for a year or so, but never introduced myself. I still get intimidated in that man’s world of the doctor’s lounge. It’s not just me, my female partner was urged by her male recruiter to eat with him every morning in the lounge when she started seven years ago, and chit chat with …

Azithromycin and long QT syndrome: Facts from a cardiologist

John Mandrola, MD

Medications

May 4, 2013

Text message: “John, This cough and congestion is killing me. It’s turning thick and green. Can you write me a Z-pak? It always works for me.”

If you write a blog on medical decision-making and heart rhythm matters, it seems an incredible omission not to opine on the FDA warning concerning the commonly used antibiotic azithromycin (the drug in a Z-pak). Quoting directly from the FDA warning:

[Azithromycin] can cause …

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Azithromycin and long QT syndrome: Facts from a cardiologist

My first day at the pediatric oncology clinic

Ashish C. Massey, PhD

Medical Education

May 2, 2013

“Aren’t those decorations looking nice?” asks a soft voice beside me.

Startled, I turn to find a young woman wearing a red-and-white sari. Her head and face are swathed in the folds of the sari, leaving only the large red bindi on her forehead clearly visible.

We’re sitting on a grassy tuft amid a large campus green. All about us stand buildings with signs in both Hindi and English. Atop the central …

Planting drug industry-funded papers in medical journals

Martha Rosenberg

Medications

April 29, 2013

Where did the medical community get the idea that Vioxx, Trovan and Baycol were safe and the benefits of Prempro, Neurontin and bisphosphonates outweighed their risks? From research published in medical journals written by drug companies or drug-company funded authors.

Scratch the surface of many blockbuster drugs that went on to be discredited, or even withdrawn as risks emerged, and an elaborate “publication plan” emerges, developed by …

A plea for a universal, unified EMR

James C. Salwitz, MD

Health Technology

April 29, 2013

At some point, this gets to be ridiculous. Online, I can buy any item from anywhere at any price, pay any bill, watch any movie, listen to any song, order dinner, schedule car repair or read about any subject on Wikipedia. I can determine the weather in Rio, sport scores of Barcelona, Parisian traffic or by GPS the location of my kids, just down the block.

However, I absolutely cannot learn …

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A plea for a universal, unified EMR

How would you react to a cancer diagnosis?

Suzanne Koven, MD

Physician

April 26, 2013

There’s this weird feeling I get when I hear bad news, or even not that bad news, or even the possibility of bad news: a tingling that spreads across my forehead, down my face, into my jaw, and then to my chest, where it settles like a…no, not a lump…a void. I get the feeling every time I go for my annual mammogram or any other medical test, I wonder …

Lean in: The subtle complexity of having it all in medicine

Genevieve M. Boland, MD

Physician

April 24, 2013

As an intellectual female surgeon, I have always resented being pinned down by my gender. Throughout medical school, I refused to join “Women’s Societies”. I felt that these were excuses for disillusioned women to get together and complain that the reason they were not succeeding was their gender. I, on the other hand, did not feel limited by my gender nor did I hide it. Instead, I relished it. I …

As an oncologist, I hate running late

James C. Salwitz, MD

Physician

April 22, 2013

Yesterday I had office hours: 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day. However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve. I really hate it when patients are late.

Now, I have to admit this is a unique …

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As an oncologist, I hate running late