Oncology/Hematology

How political correctness interferes with healthcare

Physician
December 14, 2011

Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” “obese,” or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to …

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Saying no to your oncologist is sometimes the right thing to do

Physician
December 11, 2011

Cancer is a dreadful disease. Just dreadful.  Make no mistake: I have tremendous respect for the awesome doctors who treat patients afflicted with it day after day. Still, paradoxically, I can’t help but notice that some of them have just as hard a time as do other doctors with caring for patients at the  end of their lives. I believe a large part of their difficulty stems from the ridiculously …

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MKSAP: 42-year-old woman with lymphadenopathy, fatigue, and edema

Conditions
December 10, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 42-year-old woman is evaluated for a 3-month history of progressive cervical lymphadenopathy, fatigue, night sweats, bilateral lower-extremity and abdominal wall edema, and a 4.5-kg (10.0-lb) weight gain. History is significant for three episodes of weight gain and facial and lower-extremity edema lasting 4 weeks in …

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How alternative medicine may have killed Steve Jobs

Conditions
October 30, 2011

When they first discovered the tumor in his pancreas in October 2003, his doctors told him an immediate operation was necessary, and could lead to a cure.

As first reported by Peter Elkind in 2008, Jobs decided to think different, declined surgery, and explored alternative medicine treatments for his disease.

Nine months later, in July 2004, the tumor had grown. Only then would he allow his doctors to operate.

Would Steve Jobs be alive today had he consented to surgery when they first discovered …

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How to create your medical family tree

Conditions
November 16, 2010

The holidays are a great opportunity to ask family members about their health history.

Learning about your family’s health history can help you answer your doctor’s medical history questions. It can even help your doctor determine if you may be at risk for an inherited cancer like breast, colorectal, ovarian, prostate or endometrial cancer, which sometimes run in the family.

Keep in mind that just a small portion of cancers – about 5 …

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Breast cancer and understanding your breast type

Conditions
October 15, 2010

What does your breast type say about your cancer risk? Quite a bit, actually.

Whether you have large, small or lumpy breasts, self-awareness is very important. Getting to know how your breasts look and feel can help you recognize possible red flags.

Large vs. small breasts

When it comes to cancer risk, size really doesn’t matter. But, size can affect your mammogram and clinical breast exam.

For example, women with large breasts may need …

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Watchful waiting is underutilized for most men with prostate cancer

Conditions
October 8, 2010

NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine.

If you look at the article, you may notice a very small subheading above the article’s title. It reads “Less is More.”

Very telling.

The thrust of the article and the …

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10 cancer signs women shouldn’t ignore

Conditions
September 22, 2010

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If you’re relatively young and healthy, gynecologic cancers probably aren’t on your radar. But they should be.

This year, more than 80,000 women in the United States will get a gynecologic cancer, such as endometrial (a.k.a. uterine), ovarian or cervical cancer. In general, gynecologic cancers occur more frequently in women after menopause, although they can occur in younger women. While all women …

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Root beer bonds a chemotherapy patient with his oncologist

Conditions
August 30, 2010

by Krupali Tejura, MD

I am treating a patient for head and neck cancer — which can be one of the most harrowing therapies.

To receive chemotherapy and radiation concurrently can be pretty debilitating. Swallowing foods can be next to impossible, and the taste changes and saliva changes are brutal. It’s one of the harshest areas to treat … and I warn the patients beforehand: …

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When a biopsy cannot completely rule out cancer

Conditions
July 30, 2010

Pathologists and radiologists don’t have the luxury of spending time with actual patients so they have to render professional judgments and determinations based on indirect data (radiographs, a mashed up slice of breast tissue, etc.).

I don’t envy them; the utter detachment from patient care would make me miserable. But they do have a tough job. They get one shot at getting it right. There’s no patient follow up. They never …

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President Obama should have had colonoscopy without sedation

Conditions
April 19, 2010

by Michael Kirsch, MD

Does anyone out there know why President Obama underwent a virtual  ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year?

In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For …

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Radiologists and communicating mammogram results to patients and their doctors

Conditions
September 24, 2009

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

Conditions
June 22, 2009

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?

Conditions
March 6, 2009

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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Bernie Mac, pneumonia, and sarcoidosis

Uncategorized
August 9, 2008

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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Defensive medicine

Uncategorized
April 4, 2007

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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A former colleague comments on Dr. Anna Pou

Uncategorized
July 26, 2006

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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When patients deny illness

Uncategorized
February 28, 2005

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?

Uncategorized
February 12, 2005

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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