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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For many physicians, the term “compassion fatigue” may imply, as the words describe, that fatigue leads to the loss of ability to feel compassion for others. After all, what physician doesn’t have a day when s/he is too tired, running on too little reserve, and feeling some degree of emotional numbness? Many physicians may not realize, however, that compassion fatigue can go much deeper.  According to the Compassion ...

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The day after I told Nell she had seven metastases to her brain, she sent me flowers. She was my patient; I was her oncologist. I had met her one year prior, when she was well into her cancer journey, stage IV breast cancer at diagnosis. I took over from her current oncologist, who was moving. At our first visit together, she grilled me without mercy. Her questions were insightful, and ...

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The return from a vacation weighed on me physically.  This had been a true vacation -- an entire week away from clinic and spent with my family.  I even managed to unplug to the point of only checking email on my phone twice per day -- really! The tension that years ago took up permanent residence in my shoulders had faded away without my noticing, so that when I awoke to ...

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There is a shortage of rural physicians in the U.S.  My specialty, medical oncology, is but one of many specialties where the shortage is especially glaring. In oncology, I think there is perhaps a fear of practicing outside the walls of a large tertiary center and leaving behind the established framework and boundaries between the doctor and patient. I know it was a fear of ...

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