When you start seeing a patient for the first time who has been treated elsewhere and the previous oncologist has not followed standard protocol, how do you present this new way of doing things without alienating the patient or sounding critical of the previous doctor?
I see these tragedies unfold so often it has become routine for me now, yet don’t think that your life was less precious, that your death is less grievous, just because you killed yourself with cigarettes. It is not too late to change your future—listen to me!
It used to be so easy. Patients with ER-positive breast cancer got 5 years of tamoxifen. You could anticipate most of the side effects. No one showed up with an armload of internet downloads ready to debate the utility of hormone therapy, the risks, and metabolism or drug interactions. No more.
Most Americans are aware that technical experts from Consumer Reports magazine consistently rank televisions and automobiles manufactured by Japanese companies higher than their US counterparts, but I believe that neither Consumer Reports nor US physicians understand how much better lung cancer treatment results are in Japan.
As often as not, the decision whether to treat or deny treatment to any elderly patient with cancer is a result of an oncologist’s impression of the individual person’s ability to benefit from and withstand the side effects of therapy. And that decision is usually based on a clinical assessment that is far more intuitive than it is scientific.
The reality is that new biological agents are often priced like a Ferrari, and patients who are covered under a pharmacy benefit are required to fork over not a fixed copay but a percentage of the pill’s cost, each and every month ‘til eternity or death, whichever comes first.
Reading the contents of the NCI Cancer Bulletin in recent years, I have become increasingly concerned by what I perceive as an irrational, pervasive, and persistent editorial bias against cancer screening.
Without naming drugs, because there are several that fall into this category, has anyone else noticed that many of the new cancer drugs show an infinitesimal improvement in progression-free survival or overall survival?
Much study has been done on how to promote the most important attribute physicians must have in order to fulfill their sworn duty: that of professionalism. For practicing physicians such frustrations as the insurance bureaucracy and the pressure to generate visits can erode that duty.
Reflections on My Visit to a Chinese Medical School—and an Unplanned Side Trip to a Chinese Hospital
As is nearly always the case with international travel, and especially in a place so different from what we are accustomed to in the United States, the whole experience was delightfully eye-opening, both for those dimensions of medical care and education that struck me as remarkably similar, as well as those that seemed wholly foreign.