How do you respond when patients with a good prognosis want to delay chemotherapy to try an anticancer diet for a few months or visit an unregulated clinic for unproven therapies? I’m asking because of an alarming finding of ASCO’s 2018 National Cancer Opinion Survey: “Nearly 4 in 10 Americans believe cancer can be cured solely through alternative therapies ...” Clearly, we have a problem in today’s discussion about cancer treatments. ...

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As an internist, I strived to give patients hope by prescribing therapies that increased their chance — their hope — of the best outcome and by encouraging them with hopeful words. My own hope was to care for patients until I was old. Just weeks after celebrating my 36th birthday, I was diagnosed with non-Hodgkin lymphoma. Throughout the ups-and-downs of my chemotherapy, I felt the kind of hope I’d wanted my ...

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Obesity is linked to many serious medical conditions. Yet many physicians refrain from talking about "the elephant in the room" for fear of offending patients. The Archives of Internal Medicine published a study with the conclusion: "Patient reports of being told by a physician that they were overweight were associated with more realistic perceptions of the patients’ own weight, desire to lose weight, and recent attempts to lose weight." When in ...

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After people have a heart attack, stroke or joint replacement, rehab is a routine part of their recovery plan. Cancer survivors, too, can have significant musculoskeletal issues during and after the acute illness. Yet cancer rehab programs are few and far between. Why is that? For no good reason, rehab has not yet made it to the culture of survivorship. It's time to do something about this. Cure Magazine published an important article by physician-survivor Julie Silver in the online ...

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If you're sick, you need people to empathize with you, right? Maybe not. Empathy is one of those words with a wide variety of definitions, especially in academic settings. From Wikipedia: "Empathy ... cover[s] a broad spectrum, ranging from feeling a concern for other people that creates a desire to help them, experiencing emotions that match another person's emotions, knowing what the other person is ...

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A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion. So let's take a look at compassion. Compassion is derived from the Latin "cum" (together with) and "patior" (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that ...

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The New York Times recently ran an article tackling a complex ethical dilemma in cancer care: the withholding of treatment in clinical trials. Because I was treated in 3 clinical trials in the 1990s, the topic is close to my heart. Scientists have advanced the treatment of disease using the scientific method. By that, I mean they have tested a theory using rigorous methods that give a reliable and reproducible answer. This ...

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[Editor's note: Please visit part 1 of Dr. Harpham's take on OpenNotes.] "Our" Chart Does the opportunity for patients to read their medical charts help or hurt patients' ability to become Healthy Survivors? Open notes can facilitate Healthy Survivorship for some patients. Unfortunately, other patients may learn something about their condition that makes it more difficult to get good care or live as fully as possible. Or they may experience feelings that threaten the physician-patient bond. ...

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Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?

The OpenNotes project is a recently launched observational research study that involves 100 primary care doctors and about 25,000 patients. Lead author Dr. Tom Delbacoa, a primary care physician at the Beth Israel Deaconess Medical Center, poses the research question succinctly: “After a year, will the patients and doctors still want to continue sharing notes?”
In the study, ...

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A patient learns about a treatment for his condition. So he goes to his physician to suggest the treatment as an option. Is there anything wrong with that? It depends on how his "suggestion" is presented. In today's age of patient advocacy and direct-to-patient marketing of pharmaceuticals, a new phenomenon is flourishing in doctors' offices: patients asking for specific diagnostic tests or therapies. I think it's terrific if you bring information and ideas ...

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