Behind every door in my clinic, is human suffering.  It hangs like a mist; I can see the living ghosts of my patients through it. As an oncologist who treats primarily pancreatic cancer, many of my patients will be dead within a year of our first meeting.  I knew this would be the case when I chose my specialty. Pancreas cancer is one of the last frontiers in cancer therapeutics:  a ...

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In July 2016, the U.S. Preventative Services Task Force (USPSTF) published updated skin cancer screening guidelines in JAMA, concluding “current evidence is insufficient” to screen for skin cancer in adults. The guidelines were formulated on a literature review of studies conducted in asymptomatic patients 15 years and older at general risk for skin cancer from 1995-2015; after identifying nearly 13,000 articles spanning two decades of work worldwide, the authors selected ...

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Dear Dad, I often think about the night you passed away.  I was caring for you while you were dying from metastatic colon cancer.  Every hour I woke up to give you Dilaudid so you wouldn't feel pain and Ativan so you wouldn't be scared.  You had only just been diagnosed eight months before.  Despite aggressive chemo, radiation, abdominal surgeries, and all the hope and prayer in the world, the cancer ...

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In the medical field, it is said that July, not April, is the cruelest month. It even has a name, the July Effect. In June, hospitals hum and smoothly operate after a year of working out the kinks. In July, they welcome, or dread, the arrival of new recruits: newly minted physicians and medical students, eager to prove themselves, yet raw and untrained. For me, as a senior resident, it ...

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When diagnosed with abdominal mesothelioma, a rare cancer with a blighted future, evolutionary biologist and writer, Stephen Jay Gould, turned his attention to the statistics; specifically, the central tendency of survival with the tumor. The central tendency -- mean (average), median and mode -- project like skyscrapers in a populated city and are the summary statements of a statistical distribution. The “average” is both meaningful and meaningless. The average utility of ...

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asco-logo Most times, I feel excited to be an oncologist. Oncology research is accelerating and every week brings more news, whether it be a deeper understanding of tumor genomics, a broader understanding of cancer genetics and risk, and, it seems, more ways to provide precision therapy. Studies are coming out showing gains in survival in many different cancers, and ...

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asco-logo The phone rang in my office one morning last week. Woman: “I received a notice of an appointment with you, and it says to bring my partner or spouse with me. This problem has nothing to do with him.” (The opening statement could just as easily be from a man, and often is.) I quickly looked up her notes in the electronic medical record ...

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It's a typical chaotic day on the hospital's hematology and oncology floor. I'm sitting in a side room with one of my fellow medical students, doing paperwork and making follow-up calls for our medical team. That's when the music starts. The sounds of two guitars, a tambourine, and a few maracas drift down the hallway. I can't make out how many people are singing, but the happy voices and the song's ...

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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 ...

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Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, ...

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