In my last post, I talked about how gadgets can interfere with civility among strangers. But what about among friends and loved ones?
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:
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:
My September 15th post in response to Penicllin Allergies Overblown introduced the problem of physicians over-prescribing broad-spectrum antibiotics when penicillin would be the more appropriate drug.
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.
This 3-minute video Gene Breakthroughs Spark a Revolution in Cancer Treatment explains how genetic markers are helping researchers separate seemingly identical tumors into those that might respond to a specific treatment and those expected not to respond.
It's a new way of thinking about cancer. What really matters? Where a cancer began? Or that it has genetic markers that indicate susceptibility to specific treatments?
If you remember only one thing from this post, may it be this: Well-funded and well-executed research is the only way to uncover truths about treating cancer.
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.
You can hate math and not give a whit about statistics. But if you care about your health, you will finish up your summer reading with a fantastic new book: Naked Statistics. Stripping the Dread from the Data.
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...
And physicians trust that their patients...
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?
Yesterday, Dr. Mikkaela A Sekeres addressed, "Keeping Cancer a Secret." He was prompted to write the essay after learning that a patient had been keeping his diagnosis of myelodysplastic syndrome [a pre-cancerous condition] a secret from his grown children and their children.
The patient explained, “'Our son has been away, doing a couple of tours of duty in Afghanistan,” he said. “We were going to tell our daughter, but. …” He paused, trying to find the right words. “It wouldn’t be fair, for her to know, to have this burden, and not him. We were planning on telling them when we’re together over the holiday.'”
Dr. Sekeres offers a few possible reasons, including "'sometimes the one thing that we can control is whom we tell...Some [reasons] are very personal (it’s my body, and what goes on inside it is my business). Some are professional (the screenwriter Nora Ephron kept her myelodysplastic syndrome a secret because she feared that no insurance company would sign off on any movie she tried to make). And some are altruistic (we don’t want others to bear the emotional weight of knowing).'"
His conclusion? "It’s our job, as doctors and nurses, to be deliberate in asking our patients how they will explain their cancer to others, to make sure they understand. Keeping such a diagnosis hushed, a secret from those who love and care for us, is an unfair burden we shouldn’t allow cancer to dictate, too."
Next: Do Healthy Survivors ever keep such secrets?
If ever an ounce of prevention was worth a pound of cure, it's when patients have teenagers at home. While most teens do okay, rattling in my head are stories of basically good kids from basically good homes who got into serious trouble:
In her book, When a Parent Has Cancer: A Guide to Caring for Your Children, author and cancer survivor Wendy Harpham, M.D. stresses the importance of...regular routines.
How you sound is as important as what words you choose. If you appear confident of being able to deal with your illness and help your children – even if you shed a few tears – they will feel comforted.
Months ago someone emailed me a request to read his new cancer memoir. If someone trying to help others asks me for help, I usually say "yes." So a few days later, a review copy arrived.
Unfortunately, after reading it and before reviewing it, I misplaced it.
Before I changed into my dress for tonight, I chopped 10 pounds of onions, hoping to empty my tear ducts. I expected to be emotional because, for me, this celebration is about much more than your receiving the piece of paper you’ll soon be framing and hanging on a wall in your home in Michigan.
We're talking about what it means to "let go." Because if patients run out of treatment options or they are nearing death, "letting go" plays a major role in Healthy Survivorship. So here's another definition:
For cancer patients who run out of treatment options, how can "letting go" help in the pursuit of Healthy Survivorship? How can it hurt?