Oncology/Hematology

Radiologists and communicating mammogram results to patients and their doctors

by an anonymous radiologist

I recently read the article and comments on this link from this post, concerning radiologists, from Musings of a Dinosaur.

I was disturbed to discover the animosity with which this topic is covered. The tenor of the blog is that radiologists are greedy, self-serving and are out to erode the doctor-patient relationship. The suggestion that radiologists would schedule percutaneous breast biopsies for their financial enhancement is both …

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Steve Jobs received a new liver, and the ethics surrounding his transplant

Orac, a general surgeon who blogs at Respectful Insolence, writes the most comprehensive entry I’ve seen thus far on Apple’s Steve Jobs’ liver transplant.

For those interested in the medicine behind the transplant, go and read his post in its entirety. I’d like to highlight some of the potentially questionable ethics surrounding the case.

For one, there is the question why Mr. …

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Why do I need a rectal exam, and what can doctors find with the gloved finger?

Have you ever wondered why doctors have to perform a digital rectal exam?

Well, look no further, as primary care doctor Rob Lamberts gives us the answers discerning readers demand.

Simply by looking at the rectum, which by the way, indeed “takes some getting used to,” can lead to significant diagnostic findings. Furthermore, does tight sphincter tone matter? And should you be worried about the large hands …

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Does masturbation really cause prostate cancer?

A small study garnered significant media attention last week, with headlines blaring an association between masturbation and prostate cancer.

Before anyone gets really worried, obstetrician-gynecologist Amy Tuteur takes a closer look at the data, and is not impressed.

The retrospective, case-control study actually didn’t reveal any significant initial findings, so the authors kept manipulating the variables until they saw a possible association.

Dr. Tuteur believes that …

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Colonoscopy by primary care doctors, is it time to start joining the proceduralists?

As mid-level providers are starting to take over primary care, can generalist doctors start doing specialist procedures?

If they’re smart, they’ll try. Better to take advantage of a specialist-favoring physician payment system, rather than wait for things to change.

Colonoscopies are among the more lucrative of procedures, and signs are pointing to a shortage of gastroenterologists in the coming years to perform them.

MedPage Today

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Prostate surgery

The PSA test for prostate cancer screening has come under fire. First of all, it’s not very specific – meaning there is an unacceptable false positive rate (i.e. positive test in the absence of disease) for prostate cancer. This leads to biopsies and surgery that may not be needed.

The implications of this is becoming more widely publicized. Men are starting the realize the downsides of …

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Bernie Mac, pneumonia, and sarcoidosis

Comedian Bernie Mac dies at age 50 from pneumonia. Sad news.

He had been recently hospitalized, and as recently as two days ago, it was reported he was stable and responding well to treatment. What happened?

There is very little medical information to go on. It was known that he had …

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Why the unnecessary CT scans?

For starters, not ordering a CT scan is more likely to have negative repercussions for the physician:

The cancer caused by a CT scan doesn’t generally show up for decades “” and there are all sorts of other intervening reasons why a patient would develop cancer “” so no one is too scared of getting sued for ordering a CT scan. Getting sued for not ordering one is …

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The dangers of overscreening

Those who think “more testing is better medicine” needs to become better versed in the dangers of false positives:

Many of the scans yield false-positive results, which lead to unnecessary (and risky) treatments. Even recommended tests yield a scary number of false readings. Take mammograms, an often promoted routine exam. According to research compiled by the U.S. Agency for Healthcare Research and Quality:

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Hysterectomy, the ovaries and dementia

A link between removing the ovaries and dementia?

Researchers at the Mayo Clinic compared a group of women who had their ovaries out before menopause for reasons other than cancer with a group of similar women who didn’t have their ovaries out. The women who’d had their ovaries out had a higher risk of developing several neurological problems “” including dementia, cognitive impairment and parkinsonism, which is related to …

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The US has the highest cancer survival rates

Almost every statistic you read today slams the US health care system. Not enough press is given to what we do well.

The Lancet ranks the US #1 in cancer survival rates in both men and women.

Time to give some credit when it’s due. (via Catron)

Defensive medicine

What is defensive medicine?

Defensive medicine is the deviation from sound medical practice to avoid the threat of malpractice litigation.

According to a 2005 study in JAMA, over 90 percent of physicians surveyed admitted to practicing defensive medicine. This can range from “positive” defensive medicine, like ordering unnecessary tests, referring to consultants, or performing unneeded procedures; to “negative” defensive medicine, like avoiding high-risk patients or procedures.

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Prostate cancer treatment can shorten penis length

A recent study from the Journal of Urology regrading this previously unpublicized side effect:

Men who have hormone and radiation therapy for prostate cancer can experience penile shortening, a study has suggested.

Turkish researchers studied 47 men who were receiving the treatments, the Journal of Urology reported.

Eighteen months later the researchers assessed the men again, and found a decrease in average stretched penile length from 14.2 …

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A study links firefighters to cancer

Specifically, testicular cancer, non-Hodgkin’s lymphoma, prostate cancer and multiple myeloma. The reason is that firefighters’ exposures to carcinogenic toxins occur when they are in the vicinity of the fire, not just in the fire. (via Robotic Surgery Blog)

A former colleague comments on Dr. Anna Pou

Due to intense interest in the Anna Pou story, the following post will be republished to stay current.

Original post date: 7/19/2006

Waking Up Costs offers his support:

I just learned that a former colleague and friend has been charged with second degree murder in the death of four patients at a New Orleans hospital after Katrina. I worked with Dr. Anna Pou in the operating …

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Why doctors order unnecessary tests

I’m happy that this study is getting some play in the media. Essentially, many of the “routine” tests done on a physical are not recommended (the whole concept of a “routine physical” is controversial – but that’s for another discussion). Merenstein concludes:

# 37 percent of checkups included a urinalysis.

# 9 percent of checkups included an electrocardiogram.

# 8 percent of checkups included an …

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When patients deny illness

Much denial-blogging today. Alisha’s mother-in-law won’t accept physical limitations imposed by her cancer. Orac tries to help a patient who rejects her malignant biopsy results. What is denial, and how should we approach it? (Pause for a quick check – has the Cheerful Oncologist posted about this yet? No? I’d love to know what he thinks!) Here’s Dr. Simon Wein, MD, of Memorial Sloan-Kettering …

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Are testicular biopsies necessary for the diagnosis of testicular cancer?

Man sues over “botched” testicular surgery: Another frivolous lawsuit?
“A man is suing a hospital and one of its surgeons, claiming one of his testicles was wrongly removed during surgery.

Danny Curtis claims the surgeon at Kern Medical Center did not conduct a biopsy before arranging urgent surgery to remove a testicular tumor in July 2004, according to the lawsuit filed in Kern County Superior Court.”

I …

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