It has always been my assumption that my new practice will be as “digital” as possible.  No, I am not going into urology, I am talking about computers. [Waiting for the chuckles to subside] For at least ten years, I’ve used a digital EKG and spirometer that integrated with our medical record system, taking the data and storing it as meaningful numbers, not just pictures of squiggly lines (which is how EKG’s ...

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asco-logoOne of the toughest situations in oncology is the discussion about next steps, particularly when it comes to treatment of recurrent or metastatic disease. I believe very much that it is realistic to offer a patient the hope of cancer as a “chronic disease,” that treatment can result in disease stability, even though I cannot predict how chronic “chronic” is. I was ...

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Disclosure. I am a pathologist, and I work at the interface of molecular oncology and information technology. Approximately 600,000 American cancer patients emerge uncured from standard of care treatment by medicine, surgery, and radiation each year. That is 1,600 every day. What then? Enlightened palliation on the way to hospice care does make sense for many. But now there are additional options based upon emerging science. Molecular testing of the actual ...

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Sam burst into the office, a two-year-old wild bundle of energy. Squealing with delight -- or was it distress; it was hard to tell -- he ran from toy to toy not looking at me or his mother, Jane. He was unable to engage with anything. Jane had brought him to see me in my pediatric practice because, “he hits me, has explosive tantrums, and I can’t take him anywhere.” ...

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shutterstock_111707921 America consumes 80% of the world opioid supply (99% of the world hydrocodone supply), but has about 5% of the world’s population. If you don’t think America has some kind of opioid problem, then move along because this rational, evidence-based, experience-laden way in which I’m going to discuss opioid use and misuse will not interest you. To combat our opioidification the
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The first test tube baby was born July 25th, 1978 in the north of England.  Louise Brown was called the “baby of the century” by some and a “moral abomination” by others.  It wasn’t Brown who critics accused of being immoral, of course.  She was just a blameless infant.  Instead, it was her doctors who came under fire for their new fertility treatment—in vitro fertilization (or IVF).  Roman Catholic theologians ...

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I’ve always had nagging doubts about filling out death certificates. An excellent article in American Medical News explores the “inexactitude” of the custom. Doctors are never taught how to fill out the documents. The article quotes Randy Hanzlick, MD, chief medical examiner for Fulton County, GA:

Training is a big problem. There are very few medical schools that teach it,” he said. “For many physicians, the first time they see it ...

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Radiolab recently aired a show called “The Bitter End” that discusses the end-of-life care preferences of physicians and non-physicians. Physicians are much more likely to decline “heroic” measures, such as CPR, mechanical ventilation, feeding tubes, etc. This comes as a surprise to the hosts and, presumably, to other non-physicians. It’s a good show. I recommend it. (Full disclosure: I like Radiolab.) In the show, Ken Murray argues that physicians ...

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The failure of doctors to talk to their patients about end of life decisions perplexes me.  This gap in vital communication results in poor care, uncontrolled pain, futile treatment and death in hospital or nursing home, where no patient wants to be.  Certainly, for oncologists, every patient they see is concerned about dying and by not opening the topic it leaves each isolated. I have generally taught my students that this ...

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"Discrimination against heavy people, by the general public and medical professionals, might be a greater health and social problem than any extra pounds they may be carrying" argues UCLA Professor Abigal Saguy, PhD, in a provocative essay in the Washington Post. "Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment, medical providers often blame patients for their weight and blame their ...

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