In a recent talk I gave for colleagues, I ventured outside the box. I searched for a metaphor to make cancer treatments easy to understand. Around the same time, it so happened my kids decided we needed to re-watch all of The Avengers movies at home. (In order, of course). Here’s where you get some insight into an oncologist-mom’s brain. While we watched the movies, another part of my brain cogitated on my upcoming ...

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When I first turned to writing, I had no knowledge of the field of narrative medicine. It took four years of medical school, three years of residency, three years of subspecialty fellowship and over a decade in practice before I learned of it. (That’s more than 20 years, for those counting.) Throughout, I’ve struggled to hold fast to my core belief that the key to patient care is to allow the telling ...

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I want to share how the era of immunotherapy, specifically immune-checkpoint-inhibitors, has changed the landscape of community oncology practice in metastatic non-small-cell lung cancer, for oncologists and, more importantly, patients. I want to tell you the story of Joe. A stage IV lung cancer survivor story. (Name and details changed to protect anonymity.) In 2015, Joe was diagnosed with stage IV non-small-cell lung cancer (NSCLC), adenocarcinoma. He had multiple metastases to other organs. ...

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So stated one of our children in their autobiography assignment for school.  I kept reading, curious what would come next. “My dad usually stays home and cleans up, and takes care of the pets.” I thought for a moment.  “That’s very good, honey, but do you think you could write something else about Dad?” I suggested.  “He does other stuff too, add some more nice things.” “OK, how about … ‘And he takes ...

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I am not the first physician blogger to write about the difficulties of prior authorizations, denials, and appeals, but recent occurrences in my own practice have been so convoluted that I feel they must be shared. The nonsensical denials would almost cause one to laugh, if not for the reality that each denial represents potential delay in care for the patient and redundant work for the physician. That's work that expands ...

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Mr. X. is a man in his 80s who was cured of his cancer. The question remains: at what cost? The biologic therapy and radiation which eradicated the cancer left him with the inability to swallow and need for permanent PEG tube. Due to overall frailty and multiple comorbidities, he never graduated from the SNF and continues to reside there today. I inherited his care after he completed his definitive treatment in ...

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My smile freezes on my face as my patient says to me, “I’m so glad you’re back – that I get to see Mrs. Lycette today!” He has been my patient for several years, and I am perplexed to hear him address me as “Mrs.” rather than “Doctor.” At the same time, I really do not think he means an intentional insult, so I keep my face neutral and continue with ...

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Recently I found myself sitting in my car in the parking lot of my clinic, unable to will myself to open the door. I didn’t want to head into the clinic that morning. Instead, I was filled with despair; overwhelmed with the events of the world. How can I do it? I thought. How can I walk in there and summon the energy to see my patients? An even worse thought: Why should ...

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I recently read a post by oncologist Dr. Stephanie Graff on the experience of blame, from self and others, that people with cancer are subjected to:

The talk about risk factors and early detection makes us think we can achieve perfection, and that cancer is somehow a personal fault … let us stop making accusations and blaming persons diagnosed with cancer. They are blameless.
Her post, "Read more...

My patient was sitting in a wheelchair. He was in his mid-forties, and before the cancer, had held a physically demanding job that he loved.  Now, the cancer in his spine had ended not only his ability to work, but any ability to use his legs. His wife was devoted to him in a way that seemed as natural and understated and unobtrusive as breathing. In order for me to examine him, she ...

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