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.

Learning the hard way that there is an art to medicine

Tracy Krulik

Patient

September 27, 2011

In med school budding doctors are told: “When you hear hoof beats, think horse.” The problem is that sometimes when you hear hoof beats, it’s a zebra, and when that “zebra” is a disease, your patient leaves your office misdiagnosed. I’m that patient.

In 1998 I had my first abdominal attack. I vomited for days and walked hunched over like a frail octogenarian. (For reference, I was extremely fit and twenty-seven …

Discussing a colostomy in a patient with rectal cancer

Sid Schwab, MD

Conditions and Diseases

September 21, 2011

Sturdy and thickly-built, long since widowed, cheery in a sardonic sort of way, tough and opinionated, Flora’s European roots ran deep; she’d been an Italian farm girl, and she’d rather be in her garden than anywhere else. The only reason she agreed to come inside and go to the doctor was that her bowel movements had finally gotten too painful, and too bloody to ignore. Which she had been doing, …

The progress we have made in the diagnosis and treatment of cancer

J. Leonard Lichtenfeld, MD

Conditions and Diseases

September 20, 2011

An article released by the Centers for Disease Control and Prevention in their weekly publication Morbidity and Mortality Weekly Report provides an assessment of the progress we have made in the diagnosis and treatment of cancer.

Clearly, since 1971, we have made substantial advances in the cancer treatment. We have become a larger and older nation. …

How to talk to teens about tanning beds

Dennis Hughes, MD, PhD

Patient

September 14, 2011

You’ve had the sex talk, the smoking talk, and the drugs and drinking talk. But have you talked to your kids about tanning beds?

You should. Tanning bed use can cause skin cancer, including the deadliest form, melanoma. And, using tanning beds before age 30 increases a person’s risk of melanoma by 75%.

Equally worrisome: tanning beds can become addictive. A recent study showed that 80% of college-age tanning beds users couldn’t kick the habit.

This …

Read more…

How to talk to teens about tanning beds

Andrea Mitchell breast cancer thoughts

Gary Schwitzer

Conditions and Diseases

September 14, 2011

For the past 24 hours I’ve squirmed about whether to or how to criticize NBC’s Andrea Mitchell about her on-air announcement of her breast cancer diagnosis and treatment. How can you criticize someone who is dealing with what she – and so many other women – are dealing with? But it’s now clear that some breast cancer survivors and others who know the science are critical of the message …

Read more…

Andrea Mitchell breast cancer thoughts

The dual tragedy of suffering catastrophic illness and being uninsured

John Maa, MD

Patient

September 9, 2011

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

The 2008 recession claimed my uncle’s job, health benefits, and assets, except for a small inheritance. By 2009 he found work (but not health coverage) as a consultant.

One day he noticed that his eyes were yellow. He emailed a photograph, and I immediately recognized jaundice. I …

Asking patients about their health care financial concerns

Libertad Flores

Patient

September 8, 2011

I remember joking with Dad about how he’d outlive us all. He had gone vegetarian 10 years before I was born, never smoked, took vitamins, and asked for a designated driver after his annual Heineken at the neighbor’s Christmas shin-dig. He flossed, wore a seat belt, and looked forward to annual physicals. If I tried leaving our Michigan house in the winter with more than 3 inches of skin exposed, …

The problem with early detection of disease in medicine

Dr. Joe Kosterich

Conditions and Diseases

September 5, 2011

Medicine is presented as being highly scientific. This is until information comes out which questions certain assumptions that underpin the practice of medicine.

One of the mantras of modern medicine is that early detection is good. This seems logical enough.

However there is an underlying assumption. That is that there will be a worsening of the condition if it is not detected and that treatment will improve the situation. What would happen …

An informed screening choice for breast cancer

Margaret Polaneczky, MD

Conditions and Diseases

September 2, 2011

Most women in their 40′s believe they should have annual mammograms, regardless of what screening regimen their doctor might recommend.

So say researchers in Massachusetts who surveyed women (primarily white, highly educated) ages 39-49 presenting for annual checkups. They gave the women a fact sheet about the new USPSTF guidelines on mammogram screening in their age group, and asked them to read one of two articles either supporting or Read more…

An informed screening choice for breast cancer

Taking the time to answer patient questions

Sharon Bahrych, PA-C, MPH

Physician

August 15, 2011

I was working in the bone marrow transplant clinic of an internationally known cancer center. When I looked into the patient’s faces, I saw hope as they were being worked up for a possible transplant.

I went into see a new patient. She had leukemia and had relapsed after her remission. Her sister would be the donor.

Gretchen, age 19 came in with her mom for the appointment. She was tall, youthful …

Think about mindfulness when seeing a new patient

Steve Wilkins, MPH

Patient

August 15, 2011

I had a “wow” experience recently when I accompanied my wife to interview a new doctor for her. As some reader may know she is being seen by specialists at MD Anderson Medical Center in Houston for Stage IV lung cancer. She has not had a local oncologist for the past 6 years, but she does now. And we both love this guy!

You need to understand that I have …

The problem with I Heart Boobies bracelets worn by middle school students

Ann Silberman

Patient

August 11, 2011

Many of you know that a judge in Pennsylvania has determined that the popular “I Heart Boobies” bracelets worn by middle school students are a form of free speech intended to raise awareness of breast cancer and cannot be restricted by schools.

As much as I love a good double-entrendre, I find the entire situation to be sad, particularly the misinformed comments I’ve seen made by parents of …

The choices after getting diagnosed with breast cancer can be overwhelming

Jackie Fox

Patient

August 3, 2011

One of the many things I didn’t know about breast cancer before I got a front-row seat was just how many choices it entails. I didn’t realize that so much of the experience wouldn’t have clear-cut, yes/no answers.

You’re confronted by your first choice before you even know you have cancer. When my mammogram revealed suspicious specks, I was presented the choice of a stereotactic or surgical biopsy. I opted for the …

The benefit of prostate cancer screening is controversial

Caprice Cadacio, MD

Patient

August 2, 2011

A good screening test is relatively inexpensive and noninvasive. In addition, effective treatment should be available if the disease being screened for is confirmed. Lastly, detecting the disease before a patient becomes symptomatic must be more beneficial than detection after the patient experiences signs or symptoms.

The latter point is often debated in prostate cancer screening, which is done by obtaining a serum prostate specific antigen (PSA) and performing a …

Advances in cancer treatment are hyped by headlines

Kevin Pho, MD

KevinMD

July 31, 2011

The following op-ed was published on June 5, 2011 in USA Today.

A patient recently asked me if I had heard about the new “wonder drugs” used to treat skin cancer. Indeed, I had. In a widely reported story in early June, two novel cancer drugs were found to benefit patients with advanced melanoma, a devastating form of skin cancer. These …

ASCO: Making e-visits work for cancer patients

Douglas Blayney, MD

Patient

July 27, 2011

In early February, my new patient was a middle-aged woman from here in Silicon Valley with a self-discovered 2 cm right breast mass. Her internist was all over this. She quickly had a core needle biopsy, was evaluated by one of our breast surgeons, and was referred to me for an opinion regarding pre-operative (neo-adjuvant) chemotherapy. I saw her …

The side effects of cancer treatment go beyond losing your hair

Jessica Gold

Patient

July 18, 2011

If someone asked me at this point in the year, which happens to be nearly the end of my first one, what I liked most about medical school, it would have to be the patient’s stories.

I could do without the hours of science classes and my utter lack of motivation to learn any subject that I am told is important. I could also do without the people who need …

An apology to a terminal patient with colon cancer

Jordan Grumet, MD

Physician

July 7, 2011

I’m sorry, Mrs. Lewis, for not making it to the hospital to see you yesterday.

Yesterday was one of those days when I felt like I could never catch up. My wife was going downtown for work, and we had to get up early. While she prepared, I helped my two-year-old son get dressed. We walked my wife to the train, then waited for the nanny. She was running late: I …

Use the National Cancer Institute’s Cancer Information Service

Erin Marcus, MD

Patient

July 5, 2011

Brenda Bryant learned she had breast cancer while she was sitting alone in her car in the parking lot of her grandson’s day care center. It was early evening on a Friday two years ago, and her surgeon called to tell her the results of a biopsy. “He just gave me my results and that was it,” says Bryant, who lives in Northern Virginia. “It was like there was …

Medicare should stop paying for prostate cancer screening in men over age 75

Kevin Pho, MD

KevinMD

July 3, 2011

The following op-ed was published on June 1st, 2011 in the New York Times’ Room for Debate blog.

Medicare should stop paying for prostate cancer screening in men over the age of 75.

You may be surprised to hear that, especially coming from a primary care doctor. But evidence is mounting that screening for prostate cancer is not only ineffective in older men, but may actually be harmful.

The cornerstone of …