Patient Advocacy

[Editor's Note: After extensive review by our attorneys, upper management at T. C. O. Enterprises, Inc. has determined that the copy provided by the narrator for today's subject is too controversial to print. In accordance with this opinion we have changed the milieu from the medical arts to the tonsorial. Thank you for your patience in this matter. For Español please press two. If this is a medical emergency please hang up and bese su asno adios.] hypocrisy: a pretense of having a virtuous character, moral or religious beliefs or principles, etc., that one does not really possess If you…
A life spent making mistakes is not only more honorable, but more useful than a life spent doing nothing. -George Bernard Shaw Pessimism never won any battle. -Dwight D. Eisenhower nihilism: an extreme form of skepticism; nothingness; nonexistence; an approach to philosophy that holds that human life is meaningless; skepticism as to the value of a drug or method of treatment (cf. therapeutic nihilism) When it comes to cancer care I suspect you can count on one hand the number of nihilists in this country who are also oncologists. You could probably find a higher number of the proverbial…
"The greatest obstacle to discovery is not ignorance - it is the illusion of knowledge." -Daniel J. Boorstin myopia: lack of foresight or discernment; obtuseness; narrow-mindedness; intolerance To be a doctor is to be constantly on guard against a sea of troubles, always keeping an eye out for dark clouds roiling on the horizon. Patients are fairly good at providing clues as to who or what has invaded their sanctum sanctorum. It is then up to doctors to reveal the intruder's identity and come up with a plan to eradicate him. Physicians harboring personality quirks, undiagnosed neuroses or…
Sloth...Myopia...Nihilism...Hypocrisy...Ennui... Just to pronounce them reveals the ugliness within. God forbid anyone should ever have a doctor who worships such character flaws...which reminds me of something: What better way to illustrate how these faults perform a disservice to patients than by giving examples where yours truly has committed them? Say, maybe this will lead to an invitation to appear on one of those television shows where folks are goaded into self-flagellation! Let's gather 'round kiddies and listen as the C. O. reads chapter seven of How to Be a Fantastic Doctor ,…
Last week a colleague told me about a new patient he had acquired, who had fired his old doctor for failing to diagnose the cause of the patient's rather distressing symptoms. It turns out that my friend had no problem discovering the cause of this patient's suffering, which was due to an unusual presentation of metastatic cancer. The previous doctor apparently led the patient down the diagnostic path marked by the sign "Dead End." Why did the physician who was sacked (not Sacks) fail to come up with the correct answer? That was a rhetorical question, wasn't it? I beg your pardon.…
[Editor's Note: this is an entry in an occasional series; parts I-IV can be found here.] If one needs a bit of cheering up these days, say after inadvertantly watching one of those cable talk shows, here's a suggestion: read about the medical advances made since the end of World War II. They are numerous and impressive. Despite the well-documented inequalities in disseminating proper care to the world's unhealthy one forgets that just a few decades ago there were no effective treatments for a multitude of diseases. Only a nihilist would refuse to acknowledge that we are living longer and…
This op-ed piece by Dr. Pauline Chen in today's New York Times reminded me of one of my deficiencies [Only one? If he had any sense he'd catalog the whole lot and publish it under the title "Don't Let This Happen to You." -Ed.] as a physician. The title of the story says it all: The Most-Avoided Conversation in Medicine What is this conversation that is not taking place between patients and their doctors, and why is it so difficult to perform? As I read the title I tried to think of another conversation besides the one that was shouting inside my head, the one that begins with the gambit…
But at my back I always hear Time's winged chariot hurrying near; -Andrew Marvell, "To his Coy Mistress" Exactly seven days ago I walked into Exam Room Number 3 and happened upon a woman in distress. Her symptoms, physical findings and laboratory abnormalities suggested to me that she had advanced stage ovarian cancer, which by the way is highly treatable. The usual sequence of events is to surgically remove as much tumor as possible and then give several cycles of chemotherapy, which frequently produces long term survival. In this case, though, the patient was about as likely to tra-la-…
[This is one of a continuing series...] While visiting with a patient last week we reached that awkward point in a conversation where both parties have exhausted their supply of neighborly small talk. As I stood up I really couldn't think of any other issues to discuss. The patient's problem, as they say, was obvious - it was the solution that had stymied me. He had been recently diagnosed with cancer and had plenty of troubles related to this. The complications of his malignancy could be relieved. The cancer itself although treatable, was incurable. This fact weighed upon me, producing…
Once upon a time I was caring for a nice man who was dying in a simply awful way from a cancer that seemed to revel in the act of slowly grinding his body into dust. In order to relieve his suffering the hospital staff gave him narcotics and sedatives intravenously. My job was to make sure that the doses were adequate. I had promised him and his family that we would do everything in our power to keep him free from pain. This is the kind of promise that, like a father walking in at the last minute to his daughter's school play, needs to be kept. Apparently one of the nurses didn't get the…
[Editor's note: No, you didn't miss the first 23 rules - the narrator is simply tossing them off as they materialize during the course of his normal work day. Speaking of working stiffs, unless he wins the lottery the C.O. will have more examples for you in due time] In honor of all the doctors around the world who labor with diligence and equanimity to give their patients the best care possible, I would like to share some entries from my little black book stuffed with practical tips for the practicing physician. This is merely an attempt to show readers how clinical decisions are made, or…
I've said it before and I'll say it again - in fact I just said it to a patient of mine who came in for his ten-year checkup after battling one of the nastier cancers coiled in the soft, verdant field we call "life." (He's cured now, thank God.) He expressed dire unhappiness with his weight, so I said it to him: "Exercise Beneficial In Breast Cancer Radiation Therapy." Hmm...this may be a tad inaccurate. I think what I was trying to say was that exercise is beneficial for cancer survivors. Unfortunately my words of wisdom seemed to have the same effect on this patient as the advice I gave…
One of the more curious lectures we ever received in medical school was by a retired family doctor whose job was to interject some real-life medicine into our mind-numbing freshman syllabus. One day he started his talk with these words: "Beware of the hateful patient." As he said this he paused for dramatic effect while we raised our eyebrows or shifted nervously in our seats, all too ready to get back to our cadavers. "The hateful patient?" we thought. "Oh, great. Now we have to worry about getting chewed out by people that are both sick and angry. What a bunch of ungrateful jerks they…
[Editor's Note: From time to time the narrator of this blog petitions the board of directors of Cheerful Oncologist Productions, Ltd. to reprint certain posts from his old sites that he finds interesting, although where he comes up with this delusion is beyond us. Anyway, in order to humor him and also keep our payroll for security low we are happy to reproduce this amateurish attempt, complete and without any editing, which first appeared on October 6, 2004. [Sit vis vobiscum!] Have you ever been diagnosed with a serious illness, or known someone facing such a health crisis? Do you recall…