Wendy Harpham on Healthy Survivorship

Attending: Medicine, Mindfulness and Humanity

A new book on mindful medicine may help you in your pursuit of Healthy Survivorship: Attending: Medicine, Mindfulness and Humanity. Click here to read complete post on my new website. 

When Implants Cause Cancer

Journalists often use heartbreaking stories to make a point. Those stories thrill me when they educate and mobilize people to proper action. They worry me when they risk causing undue fear and leading people away from proper action. Click here to read complete post on new website.

Making the Best Medical Decisions -- Part II

To make wise medical decisions, you need to know whether you are a believer in modern medicine or a doubter.

Making the Best Medical Decisions

Making the best medical decision for you is vital to Healthy Survivorship, and not only because doing so optimizes your chance of the best outcome. If you end up with a disappointing treatment result, your prior decisions affect--and may determine--your happiness.

Web-based App Improves Survival--Part II

How can an app improve survival?

Web-based App May Help Improve Survival

What if an app could help improve (1) survival in cancer patients, (2) patients' quality of life and (3) the cost effectiveness of cancer care? 

The Difficulty of Reporting Minor Symptoms--Part III

Recent posts outlined some of the many reasons patients may experience conflict and distress when deciding whether to call about minor symptoms. What's a Healthy Survivor to do? 

When Breath Becomes Air -- Lesson 2 (Informed Consent)

Here's a second lesson on Healthy Survivorship found in When Breath Becomes Air:  Informed consent is a process that involves sharing information and strengthening healing bonds.

When Minutes Matter

Dr. Toby C. Campbell offered a useful insight on end of life in "When Minutes Matter." The oncologist's essay opens with: "The day I realized I had bucket lists all wrong..."

Why It Takes So Long to Get Test Results - Part IV

If my scans are completed and the results are available, don't I have a right to know?

Why It Takes So Long to Get Test Results - Part III

To shorten patients' wait, why don't nurses relay scan results to patients?  Given that I desperately want to minimize the time patients wait for results, here are reasons why I think that is not the answer. 

Why It Takes So Long to Get Test Results

I welcome disagreements, such as a response to my September 9th post on how clinicians can help minimize patients' scanxiety. A reader posted, "The pollyanna spin/advice on this may help some. For me, I'd just roll my eyes and say, 'You're kidding. Right?'"

When Patients Read What Their Doctors Write

NPR's recent story, When Patients Read What Their Doctors Write, focuses on the benefits to both doctors and patients.

Doctor Priorities vs. Patient Priorities

An essay by Danielle Ofri MD highlights some key challenges to modern healthcare that fall under the category: narrowing the gap between ideal care and the care that patients actually receive.

The Story Behind the Overblown Story of Penicillin Allergiies -- Part II

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.

This week, the Washington Post relayed the CDC's warning of an impending catastrophe of drug-resistant infections.

The Real Issue Behind Redefining Precancerous Conditions

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.

Redefining Precancerous Conditions

A rose is a rose, but is a cancer a cancer? 

Who's Calling the Shots?

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?

Keeping Cancer a Secret

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?

 

Letting Go Part IV

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:

Letting Go Part III

For cancer patients who run out of treatment options, how can "letting go" help in the pursuit of Healthy Survivorship? How can it hurt?

Compassion and Computers IV

What compassion looks like is shaped by the relationship in which it arises. So let's look at the defining features of the doctor-patient relationship.

Compassion and Computers II

What could be wrong with IBM's supercomputer "Watson" helping physicians care for patients?

Doctors vs Computers

A front-page story in today's Science Times poses a provocative question in the rapidly changing world of medical diagnostics: Can computer software ever replace physicians to ensure timely, correct diagnoses?

How We Die: Discriminate Specialization

In my last post I share my discomfort with a passage from How We Die. Reading on, however, Nuland offers a useful insight about a risk of increasing specialization:

How Long Do I Have?

Few questions evoke physicians' discomfort like “Doctor, how much time do I have?”

In oncology it's a common question that comes with the territory, forcing clinicians and patients to grapple with issues of trust, hope, uncertainty, disappointment, and grief....

Power Struggles

Healthy Survivors understand the distinction between their unequal position in the doctor-patient relationship and their ultimate power. 

Decreasing The Risk of Delirium

A study designed to determine risks associated with hospitalization and delirium in patients with Alzheimer's Disease (AD) contains important lessons for Healthy Survivors.

"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.