I received a fax recently, from the office of another hematologist-oncologist, at another academic medical center. Attached to the fax cover page, with my name and fax number scribbled in slanted script, was a five-page consultation report on one of my patients. That oncologist -- I’ll call him Dr. Z -- had seen and evaluated my patient to provide a second opinion on the patient’s diagnosis and treatment. The lengthy report ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for increased hair growth on the face and chest and a 3-month history of irregular menses. She has a 5-year history of hypothyroidism. Her only medication is levothyroxine. On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 110/72 mm Hg, and pulse rate is 80/min; ...

Read more...

Before I retired in 2000, I worked in a state agency as a peer counselor, or more formally, an employee assistance program (EAP) coordinator. The "coordinator" part was there because my job description wasn't actually to do counseling; it was to assess the problem and refer the client for help. But of course both of those processes involved counseling. We just couldn't call it that. In 1986, shortly after I'd begun the ...

Read more...

The United States of America is addicted to narcotics.  I do not mean the millions of individuals who are hooked.  I mean the whole nation is jonesing for the stuff.  I also do not mean the junk that slips into our nation in coffee cans or across midnight borders.  I mean the billions of pills pouring off assembly lines.  I could blame pharma or the FDA, but the truth is ...

Read more...

From MedPage Today:

  1. Carbs May Lower Risk of Prostate Cancer. A diet rich in complex carbohydrates and fiber had a significant favorable association with prostate cancer risk.
  2. Obama Stands Pat for Now on VA, Shinseki. President Obama said in a news conference Wednesday that he is awaiting a preliminary report due next week on healthcare problems at Department of Veterans Affairs facilities before taking ...

    Read more...

When doctors tweet about oncology, they tweet about breast cancer. A lot. Last year, about 4,000 doctors tweeted about cancer generating somewhere in excess of 80,000 tweets. And more than one in four -- a whopping 26 percent -- mentioned breast cancer, according to an analysis of physician tweets that we conducted for the American Society of Clinical Oncology meeting. That doctors talk overwhelmingly about breast cancer is either a ho-hum ...

Read more...

From MedPage Today:

  1. VA Top Doc Calls It Quits. Robert Petzel, the man in charge of healthcare for the Department of Veterans Affairs (VA), resigned Friday in the wake of a growing scandal over the care provided to veterans at various VA healthcare facilities.
  2. Steroid Use in RA More Common. More patients with rheumatoid arthritis today are initiating treatment with glucocorticoids (GCs) early in ...

    Read more...

You can never be prepared for a diagnosis of breast cancer An excerpt from A Breast Cancer Alphabet. There is a hushed reverence in the waiting area outside the Oval Office. After all those years of The West Wing, one might think there would be a bustle of activity -- a swirl of smart, earnest people walking and talking at the same time. Perhaps I would catch ...

Read more...

Three months ago, Anne finished chemotherapy.  She is tired, overweight, anxious and her feet burn.  Anne sleeps poorly, cannot concentrate at work and her relationship with her husband is distant, let alone intimate.  In my office for a “survivor’s” visit, Anne asked the glaring question. “Will I recover?  Will I ever be the same?”  After a moment of thought I answer, “I hope not.” Okay, I was not really that cold.  ...

Read more...

From MedPage Today:

  1. Botulinum Toxin for Postop Afib? Injecting botulinum toxin into the fat pads around the heart after bypass surgery might stave off postoperative atrial fibrillation.
  2. Leadless Pacing Shows Promise, But Hits Snags. Longer-term results from the first-in-man study of the Nanostim leadless pacemaker showed the device continued to work as expected, but a post-marketing study in Europe has been temporarily halted following ...

    Read more...