The revolution in medicine brought about by greater understanding of genomics has led to a number of targeted therapies in cancer care.The basic concept is to first find the genomic change or mutation that leads to a disease, then learn its gene product and then develop a drug that inhibits the action of the aberrant gene product. The first was imatinib (Gleevec) for chromic myelocytic leukemia (CML.) When a ...
October 2011
All Stories
I wish House, MD was here
The wards had an odd sanguine feeling that day. The large glass pane doors were streaming a glow from the summer outside, and all was right because I had actually managed to have a lunch break. The High Care Ward is where the most intense monitoring is done so that we doctors can observe suffering in slow motion. I can't remember what brought me there but in the first bed ...
Discussing end of life issues with a teenager
Marcie transitioned to my care when she turned sixteen. She felt too grown up now to be in the same waiting room with "kids" at the children's clinic. But she wasn't doing well.Her pediatrician had suspected the problem shortly after birth. She wasn't growing normally, had nasal congestion, and more respiratory infections than usual. A sweat chloride test was ordered which was positive. The diagnosis was cystic fibrosis (CF). The ...
PSA testing: Information is better than ignorance
With just a few minutes of research on prostate cancer, you will find that it is the most common cancer in men; approximately 1 in 6 men will develop prostate cancer in their lifetime. In these few minutes you will also identify the only two methods available for prostate cancer screening: PSA tests and digital rectal exams (DRE). Alone, these exams are not very sensitive in detecting prostate cancer, ...
Direct to consumer advertising works in correction facilities
One might assume that inmates in correctional facilities would not be influenced by big pharma’s direct-to-consumer advertising (DTCA) strategies. After all, their communication channels with the outside world have largely been silenced.However, many do have access to television. And despite an increase in online pharmaceutical marketing, TV remains a common medium for trying to persuade patients to “ask your doctor” about drug X. Inmates also read magazines, another common ...
5 tips to evaluate medical websites
During my transition from public to private health, I have indeed noticed some interesting differences that have forced me to practice medicine a perhaps a tad differently. One big surprise: in private health, I have to admit that I have been pretty astounded to see that my patients quite heavily rely on the Internet before they even come to see me for their given ailments.In public health, some of my ...
The challenges of living with invisible pain or illness
In May of 2001, I got sick with what the doctors thought was an acute viral infection. But I didn’t recover. As the months went by and I didn’t get better, I felt as if I’d entered a parallel universe that I didn’t know existed. One reason this universe is largely invisible is that many people living with chronic pain or illness don’t look any different from those around ...
The power of gut feeling in cancer screening
Cancer screening has always been an emotional topic.In recent years, both prostate and breast cancer screening have come under increasing scrutiny. Studies are beginning to question the benefits of early detection, and, in the case of prostate cancer screening, whether more harm is done than good.In fact, the USPSTF recently downgraded their prostate cancer screening recommendation.In a recent study ...
An adult relationship with my patients
As a physician, I believe it is time that doctors stop shaking their fingers at patients and scolding them for "misbehaving and not complying."Most patients are adults and are increasingly educated and need to be treated that way by their doctors. Also access to previous "secret guild information" that doctors possessed has been profoundly altered by open access to high quality medical information on the Internet.Also when I interact with ...
Evidence based medicine removes a physician’s autonomy
Evidence based medicine.Just think about it for a second. This means now we actually practice medicine based on bona fide evidence? What the hell have I been doing for the past 25 years? Making it all up? And who wrote those thousands of articles I’ve read? Dr. Seuss?Evidence based medicine, or EBM, may be just another way to remove a physician’s autonomy. This trend has marched on for years, ...
How new doctors will kill private practice
What are new medical graduates looking for in their first job?According to American Medical News, they're looking for jobs with the following criteria: "The most important items would be the ability to show a stable, growing practice and quality of life ... The stability would come from a practice that generates most of their collections from commercial insurance, ...
Aggressive care at the end of life continues to grow
There are important medical studies, and then there are landmark studies–the kind of science that disrupts the entire medical community. The most recent game-changer was published recently in the Lancet.Well known surgeon and author, Dr. Atul Gawande and colleagues published this important look-back study on the intensity and variation of surgical care of 1.8 million elderly patients in the US. They put numbers to the well-known and ever-expanding problem of ...
Physicians who cash in on a woman’s desire to be beautiful
Three young mothers under the age of 40 are dead because they wanted to be beautiful. Kellee Lee-Howard wanted a slimmer body. Ditto Maria Shortall and Rohie Kah-Orukatan. Shortall worked as a housekeeper; Lee-Howard was the mother of six kids and Kah-Orukotan died at the same place where she received manicures. What do these women have in common besides being minorities? They had liposuction procedures performed by men who offered ...
Waiting is the bane of the medical system
"By the time you see the doctor, you’re either dead or you’re better," my mother-in-law told me. She had to have multiple tests, all with long waits to get the appointments and the results, before her health insurer would allow her to make an appointment with a specialist."Waiting is the bane of the medical system," a former student, an R.N., concurred. Advances in medicine and technology have improved medical outcomes, ...
How to protect baby skin during summer
Everyone wishes they had baby skin. It feels so soft and smooth; it’s perfectly adapted to induce us adults to want to clean their diaper, no matter how many times they dirty them. Like their big eyes and cute noses, baby skin it part of the whole package of being adorable. But like their eyes, their skin, however beautiful, is immature. Baby skin is thinner, has less natural ...
What if the individual mandate was unconstitutional?
An alarming article in Politico.com looks at what could happen if the Supreme Court determines that the Affordable Care Act’s individual mandate provision is unconstitutional—something that the current conservative leaning of the Court seems to indicate is somewhat more likely than not.Assuming that such a possible decision by the Court follows that of the Eleventh Circuit Court of Appeals in ruling that the mandate is unconstitutional but ...
How a medical student uses an iPad for patient care and education
iPads have been introduced into medical education mostly during the pre-clinical years. I'd like to share my experience using an iPad during my clinical year. I've found it to be exceedingly useful and versatile.I have an entire medical library in my pocket. With the touch of a button I can pull up essential texts such as Harrison's Principles of Internal Medicine or William's Endocrinology. I get these books and ...
Sugar matters when reading food labels
I was thinking about food labels recently as I scanned yet another new food product at the grocery store. It's become something of a hobby. "Oh, second ingredient evaporated cane juice (AKA sugar) and then at the end 'natural' (my quotation marks) flavors." The verdict: processed food. I don't need to know any more than that. Don't care about calories or fat grams or the other things we have been ...
What patients actually say to their physicians is largely unknown
Every once in a while, I come across a new concept or technology application that really captures my imagination.This was the case when I became aware of an enterprise whose core business is patient-physician communication.What patients actually say to their physicians -- and what physicians actually say to their patients -- is largely unknown.A company called Verilogue ventured into this previously uncharted territory and began to audio record patient-physician interactions.To ...
I do what I know is harmful for my body
For the last 3 weeks, I've been working as a sub-intern on the family practice inpatient service in one of the local hospitals. It's been quite a time! I've sure been kept busy, but learning a lot and seeing a lot. With a moment of downtime, I wanted to share a reflection I had yesterday.We're all familiar with the glamorous "saves" in medicine. It's the car accident victim that undergoes ...
Kevin Pho, MD
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How patient satisfaction can kill
Patient satisfaction is all the rage. Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country...
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
Physician
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The analogy between baseball hierarchy and medical systems
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but...
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Saving patients from Internet health information
Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are...
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Understanding what patient centered care really means
There was nothing the professor despised more then the syrup that oozed out of his partner's lips when dealing with patients. He...
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A letter of thanks to my organ donor
I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't...
Patient
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Why patient engagement is reciprocal
It is said that "turn around is fair play." So if providers (physicians, hospitals and other health care professionals) expect patients to...
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Question the price of drugs and medical procedures
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure...
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
Policy
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America has a medical care system not a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We...
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Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently,...
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Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no...
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America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who...
Tech
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Why physicians don’t want patients to have their cardiac device data
There is a groundswell of discussion concerning patients demanding to have direct access to data derived from their implantable defibrillators and pacemakers....
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Impersonal communication on the Internet fuels cyberbullying
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over...
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Health IT and doctors: A framework for successful partnerships
We are on the front lines of the healthcare revolution along side our patients and our colleagues in technology. We have firsthand...
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Break out of the prison of the American health care delivery system
Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost...
Social Media
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Why doctors should embrace Google+
Lots of pressure out there for you to be on Facebook and Twitter, right? The ultimate question, though, is how are you...
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
