Feelings of guilt can hamper Healthy Survivorship by interfering with your ability to get good care and/or live as fully as possible. But if your past actions may have -- or surely did -- play a role in your current ill health, what do you do about the guilt?
They take me back to the recently published editorials and research studies regarding the pervasive trend to record on our cell phone events as they unfold--instead of fully experiencing them. (See my post of October 29th.)
Infectious disease specialist Dr. Abigail Zuger muses in her December 10th NYTimes essay about how to calculate the number of patients doctors can see in one day--and still deliver high-quality, compassionate care.
A NYTImes Opinionator piece by Massimo Pigliucci and Maarten Boudry is a must-read short essay on the Dangers of Pseudoscience. It explains why pseudoscience is not "a harmless pastime of the gullible."
Stephen Asma is a professor of philosophy who recently had a cold. In The Enigma of Chinese Medicine, he reflects on his experience drinking turtle blood (a traditional Chinese remedy) to speed his recovery.
Asma talks about the problems of "demarcation" and "falsifiability" -- two ideas vital to Healthy Survivors.
One word that characterizes modern medicine is "rushed." Are the forces shaping modern medicine too many and too powerful to change the direction of our current path toward increasingly time-pressured, impersonal care?
Can we save time-consuming high-quality, compassionate care. Can we save time?
In today's culture, many people seem to expect definitive diagnoses--and quickly. How did this happen?
A short list of culprits might include:
a reimbursement structure that values high-tech interventions and short hospital stays
a third-party insurance system that makes it easier for families to demand (and doctors to order) more tests
social media that invites medical opinions of friends and family, as well as strangers—some with their own agendas
a federal government increasingly involved in the details of patient care, with policies shaped mostly by non-physicians.
Here and there, physicians and patients express nostalgia for a bygone era when medicine was simpler and clinicians had more time. Not me. The science and technology transforming modern medicine saved my life and spawned a survivor community over 13-million strong.
As I see it, our hope for tomorrow is tied to making changes that help clinicians with the demands on their time, as well as influencing the culture to value the time it takes for clinicians to optimize the use of science and technology in the care of each patient.
Next: Is today’s tide of change too powerful for clinicians to make a difference?
On September 28th I began a series, Saving Time, to talk about a great challenge in modern medicine: the time pressures on clinicians who strive to provide expert and compassionate care to each patient.
Compared to 30 years ago, routine tasks consume increasing amounts of time:
Journalist and infectious disease specialist Dr. Abigail Zuger tackled one rarely discussed aspect of the serious problem of drug-resistant bugs: overuse of penicillin alternatives due to patients claiming penicillin allergy when, in fact, they are not really allergic.
Two patients with the exact same tumor have different outcomes. Why?
Five hundred years ago, a 3-centimeter lump in one patient that looked and felt identical to that of another patient was considered the same tumor. Yet one patient did well and the other died.
With progress in science, doctors determined that tumors that look alike to the naked eye can look different under the microscope. Tumors were lumped together if they looked alike, felt the same, and had the same microscopic appearance. Yet still some patients did well while others died.
With progress in science, doctors determined that tumors that look alike under the microscope can have different surface proteins (antigens). Tumors were lumped together if they looked alike under the microscopic appearance and shared a specific array of surface antigens. Yet still some patients did well while others died.
I want to share a posting by an 80-year-old physician-turned patient. Larry Zaroff is an MD-PhD cardiac surgeon who in his later years successfully scaled the peak of Chulu West (a 22,000 foot ascent) near the Nepal-Tibet border.
My August 14th post responds to Scientists Seek to Rein in Diagnosis of Cancer, in which Tara Parker-Pope discusses the recommendations of an NCI panel that some premalignant conditions should be renamed to remove the word "cancer" or "carcinoma." The move was prompted by concerns about patients being over-diagnosed and over-treated, a problem for both Healthy Survivors and public health.
For some people, the issue is money. Increasing the use of tests and treatments helps those on the prescribing/delivering side and hurts patients and insurance companies footing the bill. They object to lobbyists and politicians having any say in determining what's best for patients.
As a Healthy Survivor, I believe the fundamental issue is captured by a Memorial Sloan Kettering oncologist, Dr. Norton: "...doctors do need to focus on better communication with patients about precancerous and cancerous conditions. He...tells patients that even though ductal carcinoma in situ may look like cancer, it will not necessarily act like cancer — just as someone who is “dressed like a criminal” is not actually a criminal until that person breaks the law.
I've devoted much of my writing life to demonstrating how substituting one word or phrase can make a world of difference to patients. Yet I still believe that changing the language cannot replace effective communication.
If dealing with the uncertainty and high stakes of a potentially life-threatening disease that requires life-altering treatment, nothing replaces the time-consuming weighing of risks and benefits for the individual and developing a personalized plan of action.
In my last post, I shared my discomfort with the idea that patients would consider following online advice that contradicted that of their physician. What does it say about the modern doctor-patient relationship?
A healing doctor-patient relationship is based on mutual trust. Patients trust that their physicians...
are expert in their field
call for advice from colleagues if dealing with a problem outside their expertise
understand the patient's situation well enough to personalize their recommendations
always have the patient's welfare as their primary directive
And physicians trust that their patients...
report symptoms and concerns honestly
let their physicians know if they don't understand what their physicians are saying
follow instructions between office visits
call for advice, if they cannot follow instructions between office visits for whatever reason
know when to call for problems
So what is it about modern medicine that would lead an intelligent, responsible person to consider following advice found online that contradicts the physician's advice?
Here's the dilemma: Your loved one wants to drive, saying, "I feel fine." Your loved one's doctor said (s)he cannot drive until cleared at the follow-up visit that is still 2 weeks away. What do you do?