There are risks to privacy and informed consent embedded in the many exciting discoveries of personalized approaches to medicine. These risks vary greatly.
Fat. It isn’t said in polite company, and doctors never use it with patients because it is considered rude and inflammatory. But fat is now a disease. OK—obesity is a disease. The American Medical Association has proclaimed it as such, and now we are free to discuss it unhindered by rules of etiquette.
If you or your loved one had cancer, how would you go about picking their treating oncologist? What would you want to know about their experience in that disease? And if a patient asks you how many cases you have treated with their diagnosis, will you look at them and be totally honest?
Here’s a fun fact: most doctors will be sued at least once during their career. Physicians in high-risk specialties such a surgery have a 99% chance of being sued by age 65; even low-risk specialists have a 75% probability.
Have you ever read someone’s note in the EMR and noticed it says “normal” in every section under physical exam, when in fact, the patient has had a mastectomy, a markedly enlarged liver, 3+ edema, or (horrors!) an amputation that goes undocumented?
In the late 1960s, I quickly learned that a large proportion of requests for narcotics in this population were spurious. Patients would simulate renal stone, acute myocardial infarction, and many other painful illnesses in order to obtain narcotic drugs.
Buy toxic chemicals and support breast cancer research! Not lying—just saw an ad on TV for weed killer and it had a pink ribbon logo on its packaging indicating, “A portion of every sale goes to support breast cancer research and awareness.” We have plenty of weed killer and a perfect lawn at our house, so I am no critic of the product. But have you noticed the pink ribbon logo on virtually every conceivable item or service?
How many times have you been killed for being the messenger with the bad news? You can often tell who is going to be angry when the CT scan shows recurrent disease. It is one of many things that are so stressful about being an oncologist. Let’s be honest; over the course of our career, we give a lot of bad news.
To my oncologist: You certainly were pleasant and compassionate. You also tended to minimize the gravity of the situation when my disease progressed. I know you’re not psychic, but when things are going badly, don’t be afraid to tell me you’re worried.
Recently, the US government released new “Sunshine” standards requiring more rigorous disclosure of potential financial conflicts of interest in medicine. Such new standards are driven by revelations of misdeeds on the part of pharmaceutical and device manufacturers.