asco-logo I’d known her for almost 3 years. She had advanced ovarian cancer -- clear cell -- and was diagnosed with disease already in her chest, stage IV. She had a terrific response to neoadjuvant chemotherapy, which had resolved her extra-abdominal disease sites after three cycles. She had an aggressive interval surgery which achieved complete resection ...

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A patient of mine recently came to see me in a follow-up appointment after an emergency department visit. He had been working out at the gym, on a hot day, after he had skipped breakfast, and after his usual routine he felt extremely lightheaded. Everyone told him he looked "white as a sheet", and a physician who was at the gym told him he must go to the emergency department. In ...

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On the afternoon of July 26, I opened an email from Dr. Peter Slavin, president of Massachusetts General Hospital, where I work as a primary care doctor. Dr. Slavin frequently sends messages to all MGH employees, uncontroversial broadsides announcing new hospital initiatives, grant awards, promotions and retirements that often end with: "Go Sox!" (or, depending on the season, "Patriots!" "Celtics!" "Bruins!").

So I was not expecting that ...

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In a world of cyberchondria and a web polluted with unlimited medical data, patients are searching their symptoms, diagnoses and treatment options even before going to a physician. Nowadays, at least one third of patients go on the Internet for self-diagnosis — or, often, self-misdiagnosis. After searching for a symptom, understanding e-medical facts is not as simple as reading hotel amenities or reviewing a pizza place. This paradigm introduces new patient ...

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My 74-year old obese, poorly controlled diabetic patient with high blood pressure, high cholesterol, coronary artery disease, asthma, obstructive sleep apnea has been difficult to motivate to improve his lifestyle and his health. He is bright, sweet and caring but just not very disciplined. At each office visit, we review his medications, review his dietary habits and go through the check list of check-ups for diabetic complications including regular ophthalmology exams ...

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Several years ago, when I was working as a hospital physician in Florida, a patient’s wife said something that has always stuck with me. The service was very busy on that day, and I was doing my best to get through everybody in a timely manner. I was with a patient whose wife was at the bedside, beside herself with worry. I was focused on the main presenting complaint, but ...

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We are all familiar with the saying: "the last straw." It refers to the fable of the camel who could carry heavy loads. In the story, the camel is a beast of burden. Its owner, in an effort to transport as much straw as possible, keeps piling more and more on the camel’s back. Camels are strong and can handle a lot. But at some point, even the strongest camel will ...

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Antibiotics save lives, but antibiotics can have negative effects.  When patients have bacterial infections, we want to treat them to prevent complications of the bacterial infection, but not treat them for an excessive duration.  So we have a Goldilocks problem -- we want antibiotic duration to be just right -- neither too short or too long. Some clinical conditions have adequate research to define the Goldilocks duration.  Community acquired pneumonia only ...

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I get on the phone with a physician. She is stressed. Her tone is exasperated. Her frustration has been building and building. I hear the stress in her words. She feels like she has been juggling ball after ball after ball. Living her circus of a life. Taking care of her patients. Pulling extra shifts and doing locums. Somehow, fitting in a little bit of time when she can for her caring ...

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"OK, one more patient to go," I said to myself with my eyes quickly scanning the patient list in my hands. I was in the elevator, going up the spanking new glass tower in the giant tertiary care hospital I call my workplace. Today was turning out to be a better Monday than usual. I had worked over the weekend, so I knew the patients. And there were no major ...

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