Les called me about his PSA. "Jim, it's rising and now up to eleven and they're recommending treatment.  What would you do?" Even as a long retired MD, I still get medical calls from friends and relatives.  Actually, I feel honored and try to do my best, researching the latest journal articles and editorial opinions.  Of course, the prostate cancer literature is cloudy at best with scant evidence that the huge number ...

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How dare you! Life can change in a heartbeat. Most of us believe that our lives, our loves and all the that things that make us who we are is a gift from a higher power. One that can be taken away as swiftly as it is given. But somewhere in the shuffle of taking kids to practice, catching up on emails, worrying about bills, and the search for the perfect ...

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So a guy has his car towed to the mechanic. All four tires are slashed. He has a simple request. Please replace the tires. But this is one of those comprehensive care mechanics. He not only examines the tires, he does a full once over. He pops the hood and immediately knows that the engine is shot. It's fried. The cost of fixing the engine is more than the value of the ...

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When I graduated residency and started my first job, I walked around the ED confidently, chest slightly pumped up at all times. I knew I was well-trained. If there was a sick patient, I was going to resuscitate them. If there was an impossible central line that was needed – I was going to get it. Difficult intubation? No problem. There was no procedure that was too difficult for me. Many ...

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“Throw grandma under the bus” clearly conveys anger, sympathy, and fear when health care decisions are made outside the realm of medical professionals. Within the doctor-patient relationship, alignment of physician expertise with an individual’s personal decision should keep insurance company executives, hospital CEOs, and government authorities from interfering. Are we naive to believe interference isn’t already occurring? A doctor orders a breast MRI to further evaluate an abnormal mammogram, but the insurance ...

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Once upon a time, I was a newspaper journalist: I chased down sources and sweated over deadlines. Then, in mid-career, I switched to doing marketing and communications for a regional healthcare system. This consisted of a large hospital and many outpatient clinics, including a community cancer center. Because I handled communications work for the cancer center, I also had a seat on the cancer committee -- an oversight group of oncologists, ...

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I lost another patient to hospice last week. She was 49-years-old. Three years ago, she was diagnosed with stage 3 cervical cancer. She was treated with surgery and chemotherapy and went into remission and stayed there until she died. After the chemotherapy, she stayed anemic. She was weak, didn't take care of her insulin properly and didn't eat. Her kidneys slowly lost function because of her noncompliance, her HgA1c climbed to ...

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Before you can even form a thought, emotions are influencing your judgments. -Zimmerman and Lerner It’s 9am on a Monday, and our palliative care team circles a table to prepare for the workday. Before us is a list of names, each representing a patient and his or her needs, support system and care team. Many are referred to us because they are suffering -- be it pain, agitation, emotional distress, existential crisis ...

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I think we are overly limited by our descriptive terms.  We throw around concepts like hospice and palliative care, but in reality the medicine I practice is much more a hybrid.  Many of my patients are elderly, demented, and plagued by metastatic disease.  Often when one of them becomes ill, it is unclear if they are merely treading water, or about to drown.  The problem with our modern definitions is that they leave little ...

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While recently confronted with a cancer scare and several months of inconclusive diagnostics, I found myself thinking about how I want to die. Following some reading, my first answer was to die at home, with control over my care, and without substantial pain, views that are widely shared by others. But the more I thought about this, the less satisfactory the answer seemed. For instance, being at home was never of high ...

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