When my 40-year old sister was diagnosed with terminal brain cancer, her one, overriding wish as the days ticked down was to die in her own home with her husband Steve and me sitting next to her, eating meals she liked that we cooked as opposed to coping with the institutional food she was being served, and for her three beloved cats to be lying on the bed with her.
It …
Diagnosed with brain cancer: An insurer adds to the nightmare
My membranes ruptured at 22 weeks during my pregnancy. It was the evening of July 5th, 2003. Two days later my first son was born and died. The task before me was bed rest and squeeze as many more days (hopefully weeks) out of the pregnancy as possible to save my other two sons. It was, to put it mildly, a very low time.
To pass the hours I read, slept, …
I wonder what Lance Armstrong tells his kids
Complications from my cancer sent me to the hospital again recently. The news that I was in trouble came unexpectedly from my oncologist’s office Thanksgiving eve, following a routine blood test. “Your liver numbers are out of whack.” My response was “Really?” as if I’d been notified that my driver’s license had expired.
I was diagnosed with a blocked bile duct and I …
Experiencing the revolving door of physicians in the hospital
“Lance Armstrong is a bad guy who has done some very good things.”
These are the words of a sports radio personality I listened to yesterday. He was obviously commenting on the confession (to my pal Oprah) by Armstrong about his use of performance enhancing drugs. The sportscaster, along with many I heard talk on the subject, were not as upset by the …
Is Lance Armstrong really a bad guy?
The patient – blue-eyed, red-haired, and healthy but worried looking – guided the doctor’s hand to just below the angle of her jaw, where a small lump was barely palpable. She had first noticed the swollen lymph node after a cold and thought nothing of it at the time. But five months later, it was still there. She knew it was nothing, …
To CT scan or not: What is the ultimate goal of patients?
It happened again today. A youngish man, age 59 (youth being relative these days) comes in for a consultation. His history began eighteen months ago when he started to notice hoarseness. Thinking he had laryngitis, he saw his primary care doctor. He was indeed diagnosed with laryngitis despite the fact that he had not been shouting for his grandson at the local soccer playoffs, nor had he had upper respiratory …
In oncology, hoofbeats are nearly always from zebras
Terry is a particularly difficult patient. She is not hard because of her cancer, which is in remission, nor is there a problem with pain, of which she has little, and Terry is not particularly demanding for the nursing staff. No there real problem, the challenge, the thing that makes her so difficult is that Terry is married. Terry is married to Dr. P and he is a particularly difficult …
Taking care of other physicians and their families
An editorial by two oncologists in the New Year’s issue of Annals of Internal Medicine discusses overdiagnosis, a controversial health problem that some have called “a modern epidemic” but others, including the editorialists, feel is a minor concern. Although many chronic conditions are overdiagnosed, cancer is the most thoroughly studied, as well as the most emotionally charged.
I am a generally healthy man with no family history …
Overdiagnosis: An epidemic or minor concern?
The best clinicians I have worked typically speak enthusiastically of how much they learn from their patients. Perhaps because it is (happily) not a daily event, or perhaps because it is so much more personal, clinicians do not talk much about what they have learned from being a patient themselves. The other end of the stethoscope is a good place to learn about medical care.
During the diagnostic phase of my …
The best physicians learn from their patients
Here is a little appreciated fact: Patients cannot order medical care; they can only accept or refuse it. Only a doctor can order medical treatment. In an extreme medical situation, the doctor can offer CPR, but it is the patient’s job to accept or reject. Any patient can refuse CPR. This refusal is known as Do Not Resuscitate or DNR, and for obvious reasons needs to be made ahead of …
When is making the decision to be DNR appropriate?
Not everything that is faced can be changed. But nothing can be changed until it is faced.
– James Baldwin
She sits in the examination chair reeking of cigarette smoke. “I had a new sore under my tongue last week,” she tells me. “It was bad.”
A year ago, she finally developed a large throat cancer from her years of smoking and drinking. The cancer had spread to the neck lymph nodes and …
I will talk to my patients about smoking: Again and again
Recently, an article was published in the New England Journal of Medicine questioning the utility of mammogram screening for prevention of death from breast cancer.
The authors were research professor Archie Bleyer MD at Oregon Health and Sciences University in Portland, an oncologist who was chief of pediatrics at MD Anderson Cancer Center and H. Gilbert Welch MD, MPH, a professor at …
Should I be screened for breast cancer? There’s more than one answer
I am a cystic fibrosis (CF) patient with a complex medical history that either intrigues or intimidates medical providers. At 40, I’ve dealt with a lifetime of progressive lung disease, gastrointestinal complications and other later onset issues from CF such as osteopenia, diabetes and bowel cancer. I often joke that the recessive CF gene that my identical twin sister and I inherited from our Japanese mother and German father is …
Organ recipients need strong partnerships with their doctors
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Now here is a novel idea to save lives and stop the cancer plague; stop trying! Sounds as crazy to me, as it does to you, but this idea actually may have merit. Some smart people are saying that we have spent too much money for little gain, thus it is time to give up and by retreating win more battles in the war on cancer, than by charging ahead.
The …
Finding a cancer cure: Maybe we should shift gears
My wife Elaine was hospitalized for 6 days recently with an array of ailments related to her advancing cancer, so diagnosing and addressing her problems required a multidisciplinary approach. In addition to the nursing and support staffs, she was tended by an emergency physician, two hospitalists, three gastroenterologists, a pulmonologist, an infectious disease physician and an interventional radiologist. With the exception of one specialist who had performed a procedure on …
Health information exchange is the foundation of care coordination
In September the United States Preventive Services Task Force, a panel of medical experts, concluded that tests to screen for ovarian cancer do more harm than good. As a result, insurers will not be required by federal law to pay for such tests.
And the announcement was met with near silence.
Why was this recommendation greeted with such malaise when the same panel’s earlier and similar conclusions about Read more…
Screening for ovarian cancer: Where’s the outrage?
We are often pulled in different, opposing directions, and take time to find the balance between acceptance and anger, surrender and control, individual and group, being and thinking, living and dying. How we find balance and what that balance is influences our attitude.
Throughout my journey, I was struck by a number of dichotomies, or dualities, as I reflected on my reactions …
The duality that cancer patients face
As a patient, you’re entitled to ask your health care providers anything. In that sense, there are no bad questions.
But some questions will help you get more out of your interaction with your health care providers than others. This advice comes from my experience as a medical oncologist and a cancer survivor.
Before asking your questions, remember that you’re dealing with a …
How to get the most out of your oncology appointments
I had a conversation with a family practice physician today, a man who is far closer to the end of his career than the beginning. He is part of a private practice group that recently was sold to one of the larger hospital groups in the area, which put him on a salary, but also allowed him to work only three days per week. He stated that the decrease in …
The physicians of today have given up their unique soul
Doctors at Memorial Sloan-Kettering Cancer Center recently declared they would not use Zaltrap (Sanofi), for advanced colorectal cancer. In a New York Times editorial, they suggested the extraordinary cost for incremental benefit could not justify its use. Sanofi appeared to cave to the pressure and announced a 50% discount – which only made things worse.
This August, Zaltrap received FDA approval for the treatment of advanced colorectal cancer. In …
Dramatically influence drug prices by positive action
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