James C. Salwitz, MD

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

Each line on the radiology list is a patient’s line in the sand

Physician

October 28, 2019

Lists guide our lives. Some are easy, even fun, like a menu or shopping list. Some are simple tick-offs for work, like my wife’s honey-do list. Others are frightening, like a draft list. Some are melancholy, such as the inventory in a Will. We are inspired by our bucket-list. Finally, some are exciting, but stir conflict, like a wedding invitation list. I have a list, which makes me slightly anxious, a little depressed, and which takes modest courage to open …

The broader mission for hospice care

James C. Salwitz, MD

Physician

September 15, 2019

I remember it was raining outside when I told Ester she had metastatic stomach cancer. She cried, as her son sat silently holding one thin hand in two of his. After a while, she asked, how long did she have to live? I explained it depended on how well the chemotherapy worked. She smiled gently, as one humoring a silly child, and said that there would be no treatment. After …

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The broader mission for hospice care

Is the medical profession at its end?

James C. Salwitz, MD

Physician

July 8, 2017

At the graveside, they still talk about judgment, intelligence, and the wisdom that is the practice of medicine.

Deans and health care leaders wax poetic as they tell stories of great cures to lift in memoriam remarkable healers. Yet, though we bow to Hippocrates, Osler, and Salk, the time has come to mark a revolution in human history: The art of medicine is dead.

It is not that doctors have fallen from …

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Is the medical profession at its end?

This doctor gives his cell number out to patients. He explains why.

James C. Salwitz, MD

Physician

March 27, 2017

Contrary to what my wife and colleagues think, it is not all about me. Well yes, I do get lonely sitting at my desk late at night, when my wife is busy, and the long-ago-moved-away kids are not available, and there is nothing running on NASCAR. Nonetheless, it is not really about my needs. I am talking, of course, about why I give patients my cell phone number.

It is printed …

Doctors must empower their patients with knowledge

James C. Salwitz, MD

Physician

March 23, 2017

Her name is Joann. She has cancer. As that disease goes, it is not much, probably curable, one of those “if you have to get cancer, this a good one.” Still, she sits across from me, her skin pale, eyes tight and she rhythmically grasps her cold, moist hands. She fails to gain any comfort from the knowledge that she is going to be OK. Why? I have not told …

How this physician learned to cry

James C. Salwitz, MD

Physician

March 8, 2017

With thousands of cancers, thousands of families and thousands of deaths, I came to see deep time. I absorbed the finite nature of existence and gained a long view. Not just yesterday’s tests, today’s battle and tomorrow’s treatment, but the loss to come. I do not know when the reaper will arrive, but understand he will. I mourn each patient before we meet. I have learned not to cry.

Call it …

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How this physician learned to cry

It’s time we face it: Fossil fuels are killing us

James C. Salwitz, MD

Physician

February 21, 2017

When we think of pollution, we think of our planet: stripped forests paved asphalt black, sterile red rivers, brown-gray skies and creeping slums over once virgin land. We imagine massive dumps of civilized waste, the extermination of species and temperatures which bake the earth like a neglected oven. We mourn the global home in which we live, neglected, abused, in ruin. Do we ever think about ourselves?

That is one of …

A Muslim American physician goes to war

James C. Salwitz, MD

Physician

January 3, 2017

For soldiers, there are many fears. Will I do my job? Will I succeed in my mission? Will my colleagues in arms be harmed? Will I be injured? Will I die? For the American Muslim who volunteers to engage the enemies of the United States on foreign soil, there is a new worry. What will my home country do to my family while I am gone?

Recently, Dr. Ghazali A. Chaudry, …

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A Muslim American physician goes to war

Should doctors’ personal judgments affect their patients?

James C. Salwitz, MD

Physician

January 2, 2017

Medicine is a paradox. To save, we cut with sharp knives. We ignore pain so that it will light the path to diagnosis. We give toxins to destroy toxic disease. We scold our neighbors when they neglect their health, even as we work ourselves to exhaustion, eat too much and evade exercise. We comfort the families of our patients while ignoring our own.

There is one contradiction, which, by its very …

Is there a difference between a good and bad prognosis? It depends.

James C. Salwitz, MD

Physician

December 14, 2016

It was recently pointed out that one of my partners had made an error in a patient’s electronic hospital chart. Did I want to correct the mistake? Curious, I looked at the computer screen. There in 12-point-black-on-white Cambria was the culprit documentation. The words were:

“Our therapy goal is palliative. Prognosis is good.”

Now, this was clearly not what the author had intended. In common practice when someone is so sick that …

Dying holds as much meaning as living

James C. Salwitz, MD

Physician

November 30, 2016

When patients and their families seek hospice care, they are thinking about how they will die. They want to be without pain, shortness of breath, loneliness and, above all, fear. They want to end their lives with those they love, in a place they know, with respect and support. They want control. They want dignity. We all know this, and try to provide it as friends, family and caregivers. Nonetheless, …

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Dying holds as much meaning as living

Doctors are taught how to balance blood pressure, not budgets. Don’t blame them.

James C. Salwitz, MD

Physician

November 27, 2016

Not long ago, I overheard a frustrated hospital leader ranting about the poor performance of a physician. It was not that the doctor was screwing up surgeries, ordering the wrong drugs or missing obvious diagnoses. Actually, the physician was rather adept at healing his fellow man.

The doctor’s failures concerned length of stay (far too long), sloppy medical records (incomplete, loaded with cut-and-paste) and a temper, which while not directly abusive …

Why doctors resist change

James C. Salwitz, MD

Physician

November 15, 2016

In my home, we have two conversations: politics and medicine. The most vociferous discussions are around their product, health care. We know doctors on the right and left, Democrat and Republican, boisterous blues, rebellious reds and garrulous grays. Respecting opinions and debate, we love ‘em all. However, no matter on what side of the aisle they stand, which lever they pull, they share one trait. All physicians are deeply conservative. …

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Why doctors resist change

When we stop denying death we empower ourselves

James C. Salwitz, MD

Physician

November 7, 2016

Man has been dying on a regular basis for millions of years — should we not be end-of-life experts by now? Why do I feel the need to devote pages and hours to this depressing topic? Is there a goal to my project, beyond venting the shared suffering which soaks my soul? What is my purpose?

For humans, denial of death and marginalizing its effect on our lives is a major …

Why do patients accept chemotherapy, but not flu shots?

James C. Salwitz, MD

Physician

November 1, 2016

Fall brings school buses, a freshening breeze and an avalanche of meetings. There are seasonal sales, myriad projects and the splendor of colored leaves. The season is also announced, again and again, by a particular peculiar and perilous decision, which, no matter how much I try, I do not fully understand. Frankly, I just don’t get it.

“Jane, it is time to start chemotherapy.”

“What are the side effects?”

“Well, this is powerful …

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Why do patients accept chemotherapy, but not flu shots?

Quality doesn’t always equal success for doctors

James C. Salwitz, MD

Physician

October 24, 2016

I recently spent an evening with a group of medical oncology fellows as part of a small panel discussing career alternatives. There were doctors who worked for pharma, academic medical centers, hospitals and a couple of us representing private practice. The questions and comments taught me more than I could contribute. I was surprised to learn not just about jobs and personal futures, but about something basic: the difficulty in …

How one patient’s end-of-life care can affect us all

James C. Salwitz, MD

Physician

October 19, 2016

David was 42 when he died from stomach cancer. He spent the last year of his life receiving useless chemotherapy and debilitating radiation. David was in terrible pain all of the time. He stayed in bed for months as cancer destroyed his ribs, back and lungs.

Finally, David was rushed to a hospital, plugged into a breathing machine and pierced by countless IV drips. He died despite a battery of tests, …

I do not care what you say. I have to try.

James C. Salwitz, MD

Physician

September 6, 2016

Smoking and drinking caused the cancer, which Ed ignored for a long time. By the time a doctor looked at the hole in his neck, the mass had congealed the base of the tongue to the right side of the jaw and burst through the skin. A steady drip of pink tinged, foul saliva ran down the side of Ed’s neck. Ed, not being able to chew for months, was …

Doctor, you are not alone

James C. Salwitz, MD

Physician

August 23, 2016

2:15 a.m., July 2, 1981. Its 83 degrees outside in a loud, humid Chicago night, but here the scrubbed air is chilled, dry, while white tiles reflect the occasional nurse, who appear and vanish, and the rhythmic sighs of the machines, gasping somewhere down empty halls, are occasionally interrupted by a frantic chime.

My first night in the unit and my first patient’s chart. Papers spill from the accidentally opened binder …

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Doctor, you are not alone

Is taking an online medical selfie really a good thing?

James C. Salwitz, MD

Physician

July 19, 2016

Autonomous dissection by the internet. We all do it, but is taking an online medical selfie really a good thing? Disease, prognosis, and treatment explained in exquisite, exhaustive, confused, nonspecific and erroneous detail, which often yields the wrong diagnosis, recommendations for irrelevant therapy and wildly inaccurate conclusions, resulting in confusion and fear. Given this common reality, should patients avoid computer self-investigation entirely and leave e-research to the “professionals?”

The bad

Patients, left …

James C. Salwitz, MD

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