Patient Advocacy
mementomori | January 24, 2008Dr. Scott Berry, a medical oncologist at the University of Toronto, has written an interesting essay in this month's Journal of Clinical Oncology entitled "Just Say Die." His point is that doctors are hesitant to use the words "die" or "death" when counselling patients who are in the process of doing exactly that - dying:
Die is a short, simple word. The problem is that I rarely use it when I speak to my dying patients, and I don't think I'm alone.
According to Dr. Berry, one of the reasons why we eschew the "D" word when talking to patients about their prognosis is to avoid upsetting them…
mementomori | January 8, 2008A study from Duke University reveals that oncologists who hear an expression of emotional concern from their patients respond with an empathic statement only 22% of the time. In other words, patients who share feelings of distress such as anger, discouragement or fear with their doctors are likely to receive no recognition of their suffering nor any emotional support in return. As a medical oncologist I find this embarrassing.
By identifying how seldom oncologists provide empathic support to patients, the study illuminates the potential benefit of teaching such skills to doctors. Previous…
mementomori | January 5, 2008If you are an athlete or are just committed to exercising regularly, no matter what your age is, what do you do if your doctor tells you to stop it? I'll give you three possible responses:
1. "You're the doctor - if you say to stop running I'll stop."
2. "How do you know that this is the right decision? What's your experience with this?"
3. "Thanks, Doc!" (followed by this interior monologue [bowdlerized version]: "#### him! That fat ############. I'm going for a bike ride the minute I get home.")
The correct answer is below the fold.
Ahem...as usual, this was a trick question.…
mementomori | December 20, 2007Here's more discouraging news about the consequences of living without health insurance:
Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling health care obstacles.
In this study done by the American Cancer Society, researchers looked at a database of 600,000 cancer patients from 1500 different hospitals and documented the percentage alive five years after their diagnosis. The patients were all under age 65 and were separated into three different…
mementomori | December 12, 2007Beginning Jan. 1, Medicare will reimburse only $16,000 of the $30,000 total cost for hospitals to acquire and administer each treatment of radioimmunotherapy drugs. Currently, only two drugs -- Bexxar and Zevalin -- fall under this class of therapy.
What on earth is going on here? Why would our government reimburse cancer care providers for less than the actual cost of a new lymphoma treatment, not to mention the cost of the physicians, nurses, equipment and space needed in order to give the treatment at the correct dose, in the correct manner, flawlessly, without any adverse outcomes, with…
mementomori | December 2, 2007I read fellow ScienceBlogger Orac's take on the sad case of Dennis Lindberg, the 14 year old boy with acute leukemia who died after refusing to accept blood transfusions due to his religious beliefs, and felt like putting my own two cents in this dialogue.
As a medical oncologist who occasionally cares for patients who are Jehovah's Witnesses my opinion is this:
Why would cancer specialists agree to give induction chemotherapy for acute myelogenous leukemia to a patient whom they knew could not survive the treatment? Such a decision, to proceed with intensive chemotherapy in a patient who is…
mementomori | October 5, 2007Doctors constantly have to make decisions that reflect their intelligence and judgment, but sometimes they are faced with a decision that tests their personality. Here's an example:
"Should I (a) let this patient continue to ramble on, further delaying the eagerly anticipated close of my frantic day, or (b) cut him off now and risk committing the offense of indecorum?"
This week one of my patients made such an accusation against a specialist I sent her to. "He was rude," she said. "He kept interrupting me every time I asked a quesiton. He didn't seem to be interested in my problem and…
mementomori | September 13, 2007Men become accustomed to poison by degrees.
-Victor Hugo
"Cephalon says improper use of pain medication caused deaths in cancer patients"
FENTORA (fentanyl buccal tablet) is a potent opioid analgesic, intended for buccal mucosal administration. FENTORA is formulated as a flat-faced, round, beveled-edge white tablet.
FENTORA is designed to be placed and retained within the buccal cavity for a period sufficient to allow disintegration of the tablet and absorption of fentanyl across the oral mucosa.
FENTORA employs the OraVescent® drug delivery technology, which generates a reaction that…
mementomori | September 6, 2007"Doctors who score poorly on communication more likely to generate complaints"
Doctors who score poorly in the communication portion of a skills examination they take before becoming licensed are more likely to be the subjects of complaints to regulatory authorities later when they're practising physicians, says a new Canadian study.
Good evening, class. Today's lecture is entitled "How to Develop A Winning Bedside Manner." I see that the room is filling up - could some of you in the back please move up front? C'mon, don't stand back there like a bunch of f***ing morons - get down here and…
mementomori | July 16, 2007Hey, guess what? One of these things is not like the other - can you determine which anti-cancer treatment does not belong in this list?
JM-216 (satraplatin): an oral platinum analogue active against hormone-refractory prostate cancer
JM-/AMD-473 (picoplatin): an intravenous platinum analogue showing promising activity against small cell lung cancer
Diaminocyclohexane [DACH]-based AP-5346 and aroplatin/liposomal cis-bis-neodecanoato-trans-(R,R)-1,2-diaminocyclohexane platinum (II) [L-NDDP]: innovative new platinum-delivery systems
Cis-[(1 R,2 R)-1,2-cyclohexanediamine-N,N] [oxalato(2-)- O…
mementomori | June 27, 2007[Editor's Note: By a strange coincidence the following exchange was secretly recorded on the same day this report was released: "Personal Comments By Physicians Distract From Patient Needs."]
Dr. Xavier Yonder Zither: Hi, Ms. Ursaline. How are you feeling these days?
Ms. Penelope Ursaline: Not so good, Doctor. My feet are swollen and I have this pain that shoots down my hip whenever I run after purse snatchers.
Dr. Xavier Y. Zither: I hear ya - you should have seen me after I finished a 10K run on Saturday! They had to practically carry me off the course.
In well-intentioned efforts…
mementomori | June 11, 2007What's the difference between a plastic surgeon and an oncologist?
A plastic surgeon says, "I guarantee I can make you younger."
An oncologist says, "I can't make you any younger, but I will try like hell to make you older."
mementomori | May 10, 2007I've been thinking a lot about Ms. Melanson, the woman from Alberta who died after receiving the correct dose of infusional fluorouracil chemotherapy in an fatally incorrect short time. Cancer care professionals take their responsibilities seriously and are not known to be infiltrated with ignoramuses or reprobates. This doesn't guarantee that a mistake will never be made; in fact this Canadian tragedy is all the more painful because according to the reports the nurses involved were well-trained. Writing chemotherapy orders is a task that requires the highest degree of concentration. It…
mementomori | May 9, 2007Yesterday the results of two separate investigations into the death of a Canadian cancer patient were released. Both reports documented the mistakes made in the programming of a chemotherapy pump that was supposed to deliver a controlled infusion of fluorouracil over 96 hours:
On Tuesday, the Institute for Safe Medication Practices Canada released its independent report on the death of 43-year-old Denise Melanson last summer at Edmonton's Cross Cancer Institute.
A pump was supposed to deliver fluorouracil, a drug used to treat tumours, over four days, but it was given to Melanson over four…
mementomori | April 21, 2007I saw a patient of mine last week who is now around four months out from her last cycle of adjuvant chemotherapy. "It didn't go so hot" would be an understatement for this lovely woman - she suffered through most of the noxious side effects listed in the chemotherapy pamphlets.
Although she was working full time and denied any serious lingering symptoms, I sensed an undercurrent of fear coming from her, as if she had escaped from a prison camp and was now trying to walk unnoticed among those of us who have never been arrested. I asked her about a few minor things and convinced myself that…
mementomori | April 3, 2007A patient came to see me recently after finishing a "rigorous" (read: brutal) series of treatments against a cancer known to be curable. She suffered of course, as all patients suffer from the side effects of combination chemotherapy, but did make it through without disaster. Her celebration of life had begun with my congratulations on achieving a complete remission. As time passed, however, I found her struggling. She related several symptoms that I found perfectly legitimate, yet inexplicable - nothing that suggested a serious problem. We discussed the normal recovery from…
mementomori | March 17, 2007If you're going through hell, keep going.
-Sir Winston Churchill
What is it like to have to take chemotherapy?
I can't say that I know personally. I've never been diagnosed with cancer.
Then why do you feel qualified to speak on such a subject?
Because of what I do for a living. I've known thousands of people with cancer...not just casually, but actually cared for them, sometimes for years.
Alright, if you are an expert then answer this question that has been bothering me. How do you respond when patients say they can't go on any further with their treatment? How do you convince them to…
mementomori | March 15, 2007Da mihi, Domine Deus, cor pervigil, quod nulla abducat a te curiosa cogitatio: da nobile, quod nulla deorsum trahat indigna affectio; da rectum, quod nulla seorsum obliquet sinistra intentio: da firmum, quod nulla frangat tribulatio: da liberum, quod nulla sibi vindicet violenta affectio.
Do intercessory prayers (those said on behalf of another person and no, I'm not talking about having your friends quickly pray that the approaching police officer doesn't give you a ticket) have an effect on the recovery from illness above and beyond what medical treatment can provide?
Answer: Some say…
mementomori | February 19, 2007My eyes long for your promise;
I ask, "When will you comfort me?"
-Psalm 119:82
Sometimes I hear patients recite the following: "I don't care what kind of bedside manner my doctor has as long as he knows what to do for me," a rather barefaced rejection of the concept of the kindly physician. Sounds like the beginning of a beautiful relationship, doesn't it? The patient gets his problem fixed and the doctor is under no pressure to dally with a lot of unnecessary hand-holding. If all patients adopted this attitude I suspect many of us would get home a lot earlier.
Is it possible that…
mementomori | February 4, 2007ennui: a feeling of utter weariness and discontent resulting from satiety or lack of interest
Burnout has many characteristics, including fatigue, exhaustion, inability to concentrate, depression, anxiety, insomnia, irritability, and sometimes increased use of alcohol or drugs. Probably the most distinct characteristic of burnout is a loss of interest in one's work or personal life, a feeling of "just going through the motions." For the most part, burnout in physicians does not differ from that in other professions, but physicians' reactions may be unique in some respects, in part because…