I knew immediately it was a problem.  It was not just that Faith’s cancer had spread with innumerable masses in her liver, golf ball-like tumors in her lungs, punched out holes in her bones.  It was not that the chemo, third round and toxic, had failed.  Those were awful things.  Rather it was her response as I began to tell her.  As soon as I said, “I looked at the ...

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Recent research finds that many internists do not feel comfortable or prepared to care for survivors of childhood cancer. Although the rarity of childhood cancer may explain this, the fact remains that as more and more pediatric cancer patients survive into adulthood busy internists often have some survivors in their practices. These patients would have been treated during the last decades of the 20th century or the beginning of ...

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In a recent verdict a jury in Massachusetts awarded $16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47, for a missed cancer on a chest x-ray. The verdict reminds one of the words of John Bradford, the heretic, who was burnt at the stakes. “There but for the grace of God go I.” Many radiologists will sympathize with both the patient who ...

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Recently, I realized that patients coming to my office seeking vasectomies required an additional piece in their counseling. What led to this change? Earlier this month a study out of Harvard University suggested an association between vasectomy and lethal prostate cancer. Published in the Journal of Clinical Oncology, the researchers found that “men with a history of vasectomy had a 10% increased risk of prostate cancer, with a ...

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I’m a law abiding blogger. Laws are meant to be obeyed. If an individual opposes a law in a free country, then he should operate within the system to modify it. I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform. I’m not suggesting that an unwelcome ...

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I’ve always been good at pattern recognition and my visual-spatial orientation is excellent. Photography is my hobby, so it was only natural that as a medical student and internal medicine resident, I loved my dermatology electives.  Each day yielded up a new parade of interesting skin lesions and rashes, and by the end of my rotations I was confident in my diagnoses and recommendations. Contact dermatitis? Steroids!  Eczema? Steroids!  Psoriasis? ...

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This past April, just after the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated 2012 Medicare provider charge data, the New York Times published an article,"Sliver of Medicare Doctors Get Big Share of Payout." Almost everyone agrees that transparency in the Medicare payment system will likely lead to more efficient health care delivery with less waste and less fraud. However, thoughtful analysis must be performed so that undue stigmatization ...

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The first lecture in a radiation oncology residency program is “Radiation Oncology Emergencies,” to educate the new residents how to manage inpatient consultations and emergencies. While preparing my lecture this year, it occurred to me how useful this basic information would be to the physicians calling for the consultation. Sharing our thought process in triaging patient explains why we don’t rush to utilize radiation, even in cases of a cord ...

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As many of you picked up from the tone of my last article, I am feeling much, much better. As more time has passed from the disasters of six weeks ago when I lost my relationship and home (making me feel more physically ill than I had felt this entire time), my body has finally had a chance to recover. I also have benefitted from a three-week break ...

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I have written many columns urging doctors to be honest with their patients, especially about difficult news.  Too often patients are lead on false hope therapy rides, rather than empowered with honest information so that they can cope with their disease and future. Doctors are not the only ones who can keep a painful secret. I admitted Sarah to the hospital late on Saturday night.  For over two years, she had ...

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