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.
Recently, I presented Family Medicine Grand Rounds at Georgetown University School of Medicine on resolving conflicts between screening guidelines. During the question and answer session, Department Chair James Welsh, MD asked how evidence from carefully conducted clinical trials can possibly overcome powerful emotional stories of “saved lives.”
I answered that evidence-based medicine’s supporters must fight anecdotes with anecdotes. For every person who believes his or her life was extended by a …
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Stories help the public make sense of evidence
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella?
“Join my Medicare Advantage plan and get free membership to a local health club, free glasses and dental care.” This time of year, during Medicare Advantage Annual Enrollment period, the only TV commercials that annoy us more often are for lawyers who want to help us if we were injured at work or in a …
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The problem of insurance gaps in cancer patients
Dear Doctors:
I am writing no less than 45 days after my mother died from a GI bleed from ovarian cancer. Not once did my mother’s team of doctors mention palliative care. It was not until days and even hours before her death that hospice was discussed and implemented. Our family was blindsided by this.
While no one likes to talk about the topic of death, it is important to remember that …
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Why palliative care and hospice is the ultimate gift
It is a scenario familiar to all breast imaging practices.
A patient feels a lump in her breast and calls her doctor. The doctor examines her, agrees that a lump is present, and refers the patient to a breast imaging facility for a diagnostic mammogram and breast ultrasound (also known as a sonogram). At her mammogram appointment, a little sticker is placed on the lump felt by the patient, and mammogram …
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Why mammography is an imperfect test
Mammograms, pap smears and P.S.A. levels, what’s a patient to think?
Each of these procedures has been widely accepted as a means of detecting cancer early and thereby improve ones chances of survival. The tests themselves are simple to perform and have become an accepted standard of care. Patients are now being told that the United States Preventative Services Task Force (USPSTF) an independent panel of non-Federal experts in prevention and …
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Educate patients when it comes to cancer screening tests
Does your birth control pill put you at risk for cancer? Or, does it actually protect you from the disease? Recent headlines might have you wondering.
Here’s what we do know: oral contraceptives — better known as the pill — may impact a woman’s chances of developing breast and gynecologic cancers. In some cases, that means a bigger chance of cancer. In others, it means protection against cancer.
The reason? Most oral …
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Birth control and cancer: What you should know
Estelle’s lipstick was apple-red and generous. She did not limit its application to lips, but wore it in the general area of her mouth. Together with pink rouge, color stood out brightly on her pale face. She wore a threadbare dinner dress, years faded. Estelle had dressed carefully for the visit and I showed respect.
I met Estelle in the winter of her life. 92 years old, she lived by herself …
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Saying a very special goodbye
Throughout my career in oncology, I thought I was communicating difficult concepts to patients and families relatively well. Recently, my wife and I visited our daughter in Salt Lake City over Thanksgiving. Catherine is an extremely accomplished blogger and video broadcaster. So when she commented on my blogs, I paid attention. Her (constructive) criticism was my use of some medical terminology which she didn’t understand. More surprising to me was …
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Understanding the process of cancer metastasis
“I’ve been a fighter all my life,” said my new patient, a middle aged man with thinning hair, a worried wife, and a dismal prognosis. He had worked all his life as a plumber with no health insurance. When he was healthy, it was okay. But now he was sick.
I was meeting him for the first time in the community health center where I work as a family physician, tending …
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The positive effects of palliative care on quality of life
Cancers of the tongue and throat, all categorized as oropharyngeal cancers, are appearing at an epidemic rate.
The old paradigm is that such cancers most often occur in older men who drink and smoke. But this is no longer true. Now the most common cause of cancer of the tonsil and tongue is human papillomavirus (HPV). That’s right, the sexually transmitted disease. And it is occurring in ever younger people …
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Human papillomavirus and the risk of oropharyngeal cancer
What causes a doctor to commit suicide?
A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in his …
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Did hospital politics lead to physician suicide?
I remember like it was yesterday. My patient was a young blond female with two beautiful Samoan dogs. Her name was Margaret. I was only two years younger than she was. The diagnosis was poor. She was friendly when I introduced myself. And she proceeded to tell me about her health issues, how she was diagnosed and what treatment she was receiving. Marge as she wanted to be called was …
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The powerful connection of emotions in healthcare
Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” “obese,” or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to …
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How political correctness interferes with healthcare
Some of your relatives have had cancer. And, you’ve heard that people with a family history of the disease may be more likely to get cancer.
So, should you consider genetic testing to find out if cancer runs in your family?
Here’s what you need to know to make a more informed decision.
Most cancer cases aren’t related to family history.
Only about 5 to 10% of cancer cases are due to an …
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Should you consider genetic testing?
Cancer is a dreadful disease. Just dreadful. Make no mistake: I have tremendous respect for the awesome doctors who treat patients afflicted with it day after day. Still, paradoxically, I can’t help but notice that some of them have just as hard a time as do other doctors with caring for patients at the end of their lives. I believe a large part of their difficulty stems from the ridiculously …
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Saying no to your oncologist is sometimes the right thing to do
There is a fire burning in America over an issue that at times seems hotter to me than the anger against Wall Street: obesity. Time after time when I talk about taking responsibility for our individual health by eating well, maintaining a healthy weight, and exercising more, someone responds in anger.
Many would consider me to be a wellness evangelist. They would be right. For nearly a decade I was sick …
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The skinny on obesity
Well-meaning but clueless person: “Let me know if you need anything.”
Snarky me: “Really? Thanks! Empty your purse and let’s see what you have in there. Wait, is that purse Prada? I need that; I have medical bills to pay and want to look good paying them. Oh, that’s a pretty wedding ring, lots of diamonds, can I have that too?”
What you should say is absolutely nothing. This is a time …
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What do you say to a person who has cancer?
It was an invitation that made no sense. I was asked to be a special guest of the South Korean Ministry of Tourism and KMI International, a company that markets medical tourism. Why me, I wondered? As I re-read the invitation, I remembered another strange offer I received in the 1970’s during a tense period in Israeli-Arab relations.
“Hello Dr. Goldberg,” an official from the Jordan Ministry of Education had said. …
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If you want to know how well the medicine works, ask the patient
In this day and age, with excellent rehabilitation care available for nearly every injury or illness—no matter how serious—it’s hard to believe that there are millions of people who leave the acute medical system far worse off than they entered it, and aren’t routinely offered rehab. I’m talking about cancer survivors– a group of individuals known for their tremendous advocacy abilities. It’s no surprise that these folks are really starting …
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Cancer rehab dramatically improves cancer care
Test your medicine knowledge with the MKSAP challenge, in partnership with the 
