Wendy Harpham on Healthy Survivorship

"Doctor, I Use Dietary Supplements"

What are Healthy Survivors to do if they want to go against their physicians' medical advice and take dietary supplements? 

Grief and Acceptance - Part VII

Since my last post, I've been wrestling with what I believe about the struggle between grief and acceptance.

Needing more time, today I'll share Part 4 of the series "Managing Uncertainty," a topic germane to this discussion and newly available online at Oncology Times.

Scan Anxiety and Healing Hope

In my January 21st post, I shared a vignette that illustrates the notion that what you hope for affects whether your hope helps or hurts you.

Now let's look at the challenge of coping with the evaluation of a worrisome symptom. What can Healthy Survivors hope for? 

Ranting and Healing - Part II

In yesterday's post, I shared my reaction to a rant found on a cancer-related listserv. I explained my concerns regarding such expressions of anger, disappointment and frustration.

So what are Healthy Survivors to do if, for example, they learn they had not received important information about aftereffects of treatments they received?

Ranting or Healing

A recent thread on a cancer listserv included the rants of listserv members who were angry they hadn't been better warned about the possibility of developing aftereffects. This is a problem.

Managing Uncertainty Part I

Many patients struggle with uncertainty about what's happening now, what will happen in the future, and what they should do. Having dealt with illness-related uncertainty on both sides of the stethoscope, I've developed an approach that has helped me deal with my heightened sense of uncertainty in healing ways.

Your Medical Mind

My recent posts have discussed some of the difficulties of modern medical decision-making in the context of PSA testing for prostate cancer. A new book by Harvard oncologist Jerome Groopman and Harvard endocrinologist Pamela Hartzband offers help to Healthy Survivors: Your Medical Mind: How to Decide What is Right for You.

Does PSA Testing Save Lives or Not? - Part III

While the furor over PSA testing plays out in the media, my sympathies lie with men newly diagnosed with prostate cancer . At the end of the day, the patient has to decide what to do.

ACP Health TiPS on Pain

You can find innumerable books and articles intended to help patients talk about pain with their healthcare team. Yet pain continues to be under-reported by many patients. Here's a resource that may help: ACP Health TiPS on Pain.

Talking About Side Effects of Cancer Treatments

Effective communication is an essential element of Healthy Survivorship. So I felt honored when MD Anderson Cancer Center's Dr. Walter Baile invited me to write and narrate an audiovisual module titled TALKING ABOUT SIDE EFFECTS OF CANCER TREATMENTS

Hope or Letting Go - Part IV

Perhaps most troubling to me of  Hope or Letting Go, was Dr. Youn's question about whether the patient and his wife should be given a chance to say good-bye. 

Hope or Letting Go - Part II

In my last post, Hope or Letting Go, I shared the story of a physician, Dr. Youn, still troubled by an incident that happened ten years ago. Since reading it, I've been bothered by some of the questions he posed.

For example, Dr. Youn asked if concern for the needs of the patient's loved ones ever take precedence over the patients' needs?

Healing after a Doctor Visit Gone Awry - Part II

There is no one right way to obtain knowledge, nourish hope or take action. So, too, there is no one right way to heal a rift between you and your physician.

But there are good ways -- and maybe even a best way -- for you and your physician. What follows are my suggestions to the patient who, at her last doctor visit, raised her voice in frustration:

Healing After A Doctor Visit Gone Awry

Although I didn't have a magic answer for the patient in my last post who emailed me about her doctor visit gone awry, I was able to offer her some thoughts about moving forward as a Healthy Survivor.

When the Patient is the Expert

In response to my June 10th column, one commentor wrote: "The doctor may or may not be in expert in his or her field...."

Does a Healthy Survivor ever go to a doctor who is not an expert in his or her field?

Making Your Case at Doctor Visits-Part II

A commenter wrote "[A]ll of your suggestions here seem to protect the ego of the doctor.... I do sometimes feel that I need to "arm" myself. It's not the way it should be but, unfortunately, sometimes it is the way things are."

Many things in modern medicine are not the way they should be, such as waiting in a cold exam room for physicians who are running late. What's a Healthy Survivor to do?

Ammunition for Your Doctor Visit

I find it troubling when Healthy Survivors describe obtaining sound knowledge (the first step to Healthy Survivorship) as "arming themselves with ammunition" to make their case to their physician.

And the problem is....?

Free Toolbox

We are not born knowing how to become Healthy Survivors. We aren't taught in school how to get good care and live as fully as possible when living with, through and beyond cancer or other serious illness. I wish we were.

Understanding Post-Treatment Survivorship

If a picture is worth a thousand words, this 17-minute video by Eric Slade Productions is worth at least an undecillion (1 followed by 36 zeros). 

Tolerating Treatment

Your doctor dictates into your chart, "The patient is tolerating treatment well." Huh? After every treatment you feel nauseated, lightheaded, weak, headachy and, in a word, miserable. What does your doctor mean by "tolerating treatment well"?

Empathy and Weight Loss

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. 

Inconceivable: Blaming Science

Inconceivable is the story of a couple who became pregnant with the wrong embryo. Early on, we learn that church and religion had played central roles in the lives of Carolyn and Sean Savage. When faced with their health crisis, their church became a source of both support and additional pain.

Mistreated Patients

This is a painful topic for me to address,. But I will, since it is about a challenge for some patients:

What can Healthy Survivors do if mistreated? 

Talking With Your Doctors About News in the Media

In my last post I shared my response to a reader who was upset by the media reports of a new study. The commenter expressed ambivalence about discussing it with her physicians: "I don't know if it would be healthy or not to ask my doctors...if [knowing what we know today] I would have been spared this surgery."

Sharing Laughter

Theresa Brown is a nurse who appreciates the healing power of patients' humor. In a December 1, 2010 article for the NYTimes' Well blog, Brown shares a few anecdotes that illustrate how she is often amused by patients' stories that others might consider offensive.

The Big Picture

I chose internal medicine as a career because I love having "the big picture."

One of my great concerns about the changes in modern medicine is this: It is becoming increasingly common for none of the clinicians on a patient's healthcare team to have that big picture so vital to expert and compassionate care.

Anguished Debate on Witholding Rx for the Control Arm

My last post introduced a dilemma regarding modern clinical trials: Is it ethical to randomize some patients to the "control arm" of a trial where they will NOT receive the trial drug?

According a NYTimes article, one particular trial of a therapy (called PLX4032) for malignant melanoma "ignited an anguished debate among oncologists about whether a controlled trial that measures a drug's impact on extending life is still the best method for evaluating hundreds of genetically targeted cancer drugs being developed."

Open Notes and Compassionate Care

For me, the crux of the problem is this: Do open notes conflict with the ideal of compassionate care? 

Open Notes: "Our" Chart

My recent posts set the stage for asking: Does the opportunity for patients to read their medical charts help or hurt patients' ability to become Healthy Survivors?

The OpenNotes Project - Why Do We Need It?

In my August 9th post, I introduced you to the OpenNotes project. If you are wondering why we need the study, here is a two-word answer: informational technology.

The OpenNotes Project - Introduction

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

For the next few posts, we'll explore the OpenNotes project in the context of Healthy Survivorship.

Judging Others

Rabbi David Wolpe writes a wonderful blog called "Off the Pulpit" that often offers useful messages for patients. This week, Wolpe offers a tool that can help foster healing relationships, an essential element of healing for Healthy Survivors.

HON

Patients wanting to learn about their illness used to search high and low for a few drops of patient-centered information. The dilemma for modern patients has become how to sort through the flood of information available on the Internet.

HON certification can help.

A Problem with the Electronic Health Record (EHR)

In the newsletter of the Texas Chapter of the American College of Physicians, Dr. Steve Urban shares an important concern about Electronic Health Records (EHR).

Reacting to Post-radiation Risks

How did I go from rattled to relaxed in a matter of hours after learning about my risk of carotid disease due to radiation therapy I received 18 years ago? First, by putting the piece of information in perspective, as outlined in my last post. Second, by making a plan of action.

Cancer Survivorship Research: Recovery and Beyond

What a three days I've had here at the 2010 Biennial Conference. While packing my suitcase for the return home, I'm thinking about all I've heard.

Wendy in Washington

Tomorrow begins a conference entitled "Cancer Survivorship Research: Recovery and Beyond." And I have a job to do.

10 Rules for Good Medicine

I've been following a provocative blog, Musings of a Distractable Mind, hosted by primary care physician Dr. Rob Lamberts. His recent post entitled "10 Rules for Good Medicine." offers food for thought about modern healthcare. Here is a sampling, with my commentary added:

Placebos -- The Magic Cure

Your doctors evaluate your pain and conclude it is due to something benign (i.e., you don't have cancer, a broken bone or other health-threatening condition). Then they give you a prescription for a placebo. Should you sue these doctors? Or thank them?

PSA Conundrum

Imagine being diagnosed with cancer and having your doctor recommend you not undergo treatment and, instead, "Watch and wait."

What? Do nothing but watch and worry?

Rob Pardi Responds

My April 6th and April 11th posts focused on a  NYTimes story about Dr. Desiree Pardi, a palliative care physician who refused palliative care when dying.

Today let's look at her husband's view of the article. Robert Pardi's comments were posted on Pallimed to enrich -- or shall I say, to straighten out -- the discussion about his wife's decision. Although he doesn't use the term, he's telling us his wife was a Healthy Survivor. 

White Coat Hypertension

White coat hypertension (white coat syndrome) is when patients' blood pressure (BP) readings are high in clinical settings and normal in other settings.

Palliative Care

In my April 6th post I discuss the case of Dr. Pardi, a palliative care physician who chose to continue aggressive cancer therapy when she was dying. Letters to the editor about the article don't mention what I consider to be a key point.

Palliative Care Doctor Refuses Palliative Care

A NYTimes story of Dr. Pardi's dying illustrates that it is difficult to project what you will think or feel when faced with a grim prognosis.

Berk is Back

You were introduced to Dr. Bradford Berk on my Feb 19th post, The Comeback Physician. I'm happy to share the update reported in the current Rochester Review: Berk is Back.

Let me draw your attention to one of Dr. Berk's key messages:

A Good "Bye" Before Hospice

Why would oncologists (or any physicians) not say "good-bye" when they know this is the last office visit for a patient before being transferred to hospice care?

Abandoned to Hospice?

Denise commented on yesterday's post "I would feel badly if my oncologist referred me to hospice, he said goodbye, and I had no further contact with him..." Is it unrealistic to expect oncologists to stay involved with patients who are now in hospice?

Hospice and Healing Hopes

How can compassionate physicians suggest hospice without causing the patient to lose all hope?

Stopping Treatment with Hope

Commenting on a recent post, "Talking About Death,"Judy, an experienced hospice nurse, shares two illustrative experiences with end-of-life care -- one good, one awful.

A question came up: "What should an oncologist do if the patient and family insist on more treatment so the patient won't lose hope?"

Lessons for Oncology Fellows

Today I had the honor of addressing a small group of oncology fellows at Baylor University Medical Center. "Fellows" are physicians who have completed their internal medicine training and are now receiving training in a specialty (in this case, oncology). I shared stories, insights and advice.

Here are a few of the tips I offered: