When counseling patients and families about end-of-life care, I try to focus on a simple, clear standard.  Knowing that events are overwhelming and complex, I say,  “Look at each treatment, each action and each moment and ask; How does it improve quality of life?”  My goal is to reduce the choices during a chaotic time of life to the simple goal of comfort. For example, most families are very concerned about ...

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Elton John had it right: “It’s sad, so sad.  Why can’t we talk it over. Oh, it seems to me that sorry seems to be the hardest word.”  Mistakes are all to common in medicine, but can we say the “hardest word” when we’re involved? Example 1: There’s a diagnosis of recurrent lymphoma in the ICU. The oncologist gives a phone order for cytoxan, prednisone, and vincristine. The recorder, working a double ...

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From MedPage Today:

  1. Gout: Obesity's Stealth Disease. Once known as "the disease of kings," gout today clearly is a disease of commoners as well, and although it's on the rise.
  2. Can Statins Delay Death in Diastolic HF? Statins may have a role in reducing mortality in patients with heart failure and preserved ejection fraction (HFpEF).
  3. MS: Slow Progression With Vitamin D? Patients ...

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Twitter and cancer patients: What to make of the outrage?On one afternoon last week, I sat at my desk working on a paper when my iPhone buzzed, telling me I had a new message. This message, forwarded from my Twitter account, alerted me to an editorial published in the Guardian (which has since been removed because it was “inconsistent with the Guardian editorial code). Entitled, “Forget funeral selfies. What are the ethics of tweeting ...

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From MedPage Today:

  1. Low Melatonin May Up Risk of Prostate Cancer. Higher urinary melatonin levels had a significant inverse association with risk of aggressive prostate cancer.
  2. H7N9 Cases Spike in China. After a slow fall season, China has seen a recent wave of H7N9 avian influenza cases, according to the World Health Organization.
  3. Trials in Esophageal Ca, HCC Fall Short. Patients with ...

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Many years ago, Alfred Korzybski wrote that "the map is not the territory." Gregory Bateson went on to argue that the map, which represents reality, is not the reality. This distinction has implications for the role of patient voice in health care planning and policy. Today, many organizations are making serious attempts to include the patient voice in policy and decision-making. Unfortunately, more than a few of them are ...

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Not long ago a woman in my community, who was a patient of an esteemed local oncologist, died.  Let us call her “Beverly” and let us say she died of “breast cancer.”  I am familiar with the details of the case because one of my partners saw her in consult, but HIPAA and common courtesy forbid me to be any more transparent.  Beverly was very popular in our town and ...

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When I was first diagnosed with cancer several weeks ago, I didn’t have much time to think. I was just trying to survive after getting punch to the gut after punch to the gut of bad news. First I went to the ER thinking I had pneumonia, and was told that no, I had cancer. Then I was told instead of it being a more common, more relatively easy-to-treat ...

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At first glance, no diagnosis seems more terrible than cancer. Although it remains a huge killer in the developed world, cancer has also taken on new meanings in modern medicine. As an ordinary person, I certainly fear the word and would dread the diagnosis. Cancer. It has such a damning and unforgiving ring to it. After 3 years of residency in a tertiary referral center, where I’ve seen ...

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Radiation therapy is a leap of faithEach time I reach the point of recommending radiation treatment for someone with a brain tumor or head and neck cancer, I ask for a higher level of trust from each patient than usual: let us make a mask to keep you safe. Radiation therapy is already a leap of faith -- who wants invisible rays shooting through them? Fear of unknown ...

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