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.…
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 …
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…
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.
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…
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.
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…
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 …
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,"…
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 …
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…
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 …
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…
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 …
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…
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.
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…
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 …
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…
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 …
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…
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 …
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…
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 …
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…
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 …
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…
Doctors at Memorial Sloan-Kettering Cancer Center recently declared they would not use Zaltrap (Sanofi), for advanced colorectal cancer. In a New York Timeseditorial, 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 …
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…
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 …
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…
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” …
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…
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 …
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…
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 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…
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.
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…
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 …
