I first met her when I consulted on her hospitalized son, who’d been in and out several times with transient abdominal pain. He’d already been through various tests and consultations, each time improving before a diagnosis was established. When I was asked to see him he was once again on the mend, but I concluded that he likely had the uncommon …
The role of faith in a patient beating long odds
Surprise! It turns out that if every woman in the US got a mammogram every year, almost exactly the same number of them would still die of breast cancer. Why? Watch this video. Read this by TBTAM. Bottom line: mammograms don’t find aggressive cancers soon enough (by definition, you can’t), while too many of the cancers they do find were never going to be fatal anyway. This is what “over-diagnosis” …
How often should I screen for disease?
We are on a search for truth, but will we ever find it? That summarizes how I feel after reading an article in the New England Journal of Medicine, which once again raises the question of how much screening mammography contributes to the progress we have made in reducing deaths from breast cancer in …
ACS: Finding the truth about mammogram screenings
I remember you the day we met. It was five years ago. I was terrified. You seemed relaxed and at peace. I’d been invited to join the Lennox Head Club, in the town where I live and work; this over-thirty-five match was the first game of soccer I’d played in twenty-five years. I was the oldest on the team. You were the youngest. For you it was just the start …
I remember you: Rest in peace, my friend
I only met her once; she was young—in her mid-thirties—and she had been diagnosed with ovarian cancer during her pregnancy. Following chemotherapy and the delivery of a healthy baby, she underwent a hysterectomy and staging. She was ultimately diagnosed with a rare ovarian cancer: small cell carcinoma. She underwent postoperative chemotherapy and had gone into remission.
Unfortunately, it was short lived, …
A plea to oncologists to confront the treatment of rare diseases
Choosing the best treatment for cancer may be challenging and difficult. Patients should be well informed before making their choice. Communication between the patient and family and their medical team including their physician is very important.
The medical team should describe the available treatment choices to the patient and the expected results of each of them as well as their possible side effects. Patients should carefully consider the available options and …
Make the correct choice for cancer treatment: Questions to ask
This blog is about freedom and personal responsibility. I have opined that cigarette smokers should not be permitted to transfer total responsibility for the consequences of their choices to the tobacco companies, even if this industry has committed legal and ethical improprieties. I do not support the politically correct beverage ban in New York City, sure to spread elsewhere, where the …
The folly of breasts and politics
Gun rights advocates are correct: a well armed principal might have reduced the death toll from the tragic elementary school shootings in Connecticut last week. Gun carrying citizens might also have been able to take down the shooters in Aurora and Virginia Tech. To most people, after all, guns are about self-defense, not about committing crimes. As the old saying goes: “There has never been a mass shooting at a …
Jumping to quick conclusions after Newtown would be a tragic mistake
On Friday morning I was seeing a patient, chatting about the holidays. She had given me a gingerbread house making kit for my kids — which she had done annually since I had become her doctor.
“You are doing so well,” I declared, “Have a very Merry Christmas!”
“You too!” she said as we hugged and she left the examination room.
At 12pm …
As an oncologist, I thought I had the words to console the survivors
For the majority of physicians in the U.S., taking their skills abroad and providing care via medical missions in undeveloped countries is usually not an option. For me, that was always an option. I am an OB-GYN who works as a locum tenens, a traveling physician who temporarily fulfills the duties of another. This has provided me the flexibility to have …
Locum tenens prepared me to volunteer in undeveloped countries
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 65-year-old man is evaluated for a 1-month history of headaches and blurred vision, early satiety, and itching that occurs after showering. He has a 90-pack-year smoking history. He has no history of cardiopulmonary or sleep disorders, no other medical problems, and he takes no medications.
On physical examination, temperature is normal, blood pressure is …
MKSAP: 65-year-old man with headaches and blurred vision
On November 17th, I celebrated the three-year anniversary of the end of my leukemia relapse treatment. In going through the day, I thought a lot about what I went through. I thought a lot about how I ever survived it all. I remember so vividly those hopeless moments, hours, days, months of nausea, pain, and so many forms of discomfort. What stands out to me was the hopelessness and …
When there was no hope, I used my imagination to create it
Chains do not hold a marriage together. It is threads, hundreds of tiny threads which sew people together through the years.
– Simone Signoret
Allen’s cancer has continued to grow quickly. He raises his chin so I can see. I check my notes from a month ago and pull out my ruler and make new measurements. I jot down my findings and turn to look him in the eye. We both know this …
Tiny threads hold a marriage together
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Recently, millions of people around the world witnessed a remarkable feat. Daredevil Felix Baumgartner rose to remarkable heights in a capsule tethered to a helium filled balloon. At approximately 128,100 ft (24 miles) and a speed in excess of mach one (faster than sound), he leapt from his capsule and endured a free fall of 119,846 feet. At one point in the dive, he began to spin dangerously …
Heroics in medicine involve both a team and an empowered patient
I pull up a test result for my patient, and the senior resident standing behind me lets out an excited squeal.
“I’ve never seen the imaging come back positive for this,” she says. Our two-week-old infant, who already has a rare infection, also has a rare associated structural abnormality. It’s not benign, but it is fixable. The fix usually requires surgery.
As we walk over to the patient’s room to update her …
When the initial reaction to an unusual test result is happiness
Recently, while reading a post in an online chat group for people with chronic lymphocytic leukemia (CLL), I spotted an intriguing comment. At an important conference, a world-renowned hematologist had referred to a “five-year timeline” for a cure.
This took me back fourteen years, to when I’d just been diagnosed with CLL. There was a Gilda’s Club near my workplace; I’d always passed it quickly on my way home. Now I …
I do not require perfect health to be happy
Warning! I am a practicing doctor who sees real patients using an electronic medical record (EMR). My sole agenda is to provide the best patient care. I have no financial stake in information technology (IT). However, unlike the editorial board at the Wall Street Journal, Mr. Stephen Soumerai of Harvard or Mr. Ross Koppel of the University of Pennsylvania, I have actually …
Why IT is the core of the healthcare renaissance
It is not an easy time to be a physician in the United States. Attempt to order an expensive test for a patient and an insurance company is likely to second guess your decision. Try upholding the bottom line for your medical practice and the government will probably start questioning whether you are overcharging for your services. To make matters worse, …
Don’t overwhelm patients with unnecessary detail
I recently saw a 90-year old patient in my cardiology office practice. She was demented, but cooperative with the exam. A devoted daughter, with whom she lives, accompanied her to the appointment. Her dementia was severe enough to make a cogent history from the patient impossible. However, the daughter had something on her mind, and it had nothing to do with her mother’s heart condition.
“My mother’s primary care doctor wants …
The unintended consequences of boilerplate guidelines
Those who resist health care reform point to America’s great cancer care – instead, we should protect “the best health care system in the world.” After all, if we’re the best, other countries should change, not us.
Do we really have the world’s best cancer care?
A good indication is the American survival rate for breast cancer, the world’s longest. But …
Do we really have the world’s best cancer care?
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