The massive magnets of the MRI radiate fields through her brain, scanning veins, arteries and every millimeter of cortex.  Grey and white matter, containing all she is and all she ever will be, identified, cataloged, mapped.  Two centimeters under the front of her skull, just to the left of center, there is an abnormality; a one centimeter mass surrounded by swelling.  The lung cancer has spread, metastasized.  Really bad news. A ...

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Who is responsible for mistakes in health care?  Who should take credit for success or blame for failure?   Most families, patients and obviously the courts, hold the doctor responsible.  It seems to me this is reasonable; it is the obligation physicians assume and which society returns with empowerment and respect.  However, is this changing because of the Internet and big data? In 2013, most patients have spent hours on the Internet ...

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Ellen died a clockwork machine, restrained by Versed, fed by nasal tube, secretions in bags, and as her blood pressure dropped intravenous pressors accelerated in dose until blood squeezed from her extremities left fingertips dry and black as coal. Death occurred on the 41st hospital day, after 27 minutes of scripted, six rib fracturing, 360-joule electric shock CPR. A brutal case by any measure, worse because advanced cancer ...

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One of the benefits of being an oncologist is that, as a rule, people appreciate our work.  That does not mean they want to hear about our day, and the response when someone learns my vocation is rarely, “Hey, that’s sounds like fun!” Nonetheless, at least there is a modicum of respect.  However, I found a group of people with major questions about the work of cancer docs or at least ...

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Sue wondered if all doctors subscribe to the same magazines, buy the same cheap furniture, post the same worthless insurance information.   She wanted to throw it all through the receptionist window.  The second opinion was a waste of time and she had little of that.  She was there to make her family happy, but was upset they could not cope, that they were not ready to face the truth, and ...

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When I visited Allan in the hospital yesterday, I told him to get up and stroll the hall. However, when I checked in on him this afternoon, the nurses informed me that he refused to get up, even to the chair.  When I asked why, Allan told me he could not walk.  I was concerned, but when I examined him, I found his vital signs were fine, he had no ...

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Physicians are bothered by their patient’s fear.  One of the worst parts of actually caring is that when other people suffer and especially when they are frightened, you suffer with them.  It is bad when the trepidation is about something real, such as a new disease, but it is particularly disturbing when the source of the fear is confusion or bad information. There are several common sources of inaccurate terrifying data.  ...

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The Atlantic this week published a provocative article entitled “The Robot Will See You Now.”  Using the supercomputer Watson as a starting point, the author explored the mind-bending possibilities of e-care.  In this near future, so many aspects of medicine will be captured by automated technology that the magazine asked if “your doctor is becoming obsolete?” The IT version of health includes continuous medical monitoring (i.e. your watch will ...

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We think the reason doctors rarely make house calls is money.   Doctors can charge, but it is hard to charge enough to justify the time it takes to drive door-to-door, fill the tank and attend lengthy visits. Thus, the house call has faded into history.  However, I have another theory about the end of this valuable service: perhaps it is increased emotional distance between patients and their doctors. I watched an ...

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There is no completely safe dose or form of alcohol We live in a strange world. What would happen if tomorrow a common sedative was found to cause 21,000 cancer deaths every year? What if it resulted in breast cancer, mouth cancer, hepatoma and esophageal malignancies, and if the average patient lost 19 years of life?  What if the drug also killed by cirrhosis, massive upper GI bleeding, accelerated dementia, and for ...

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