Communication – Page 9 – Medical Lessons

The Flip Side of Unrealistic Optimism

March 6, 2011May 28, 2012 Elaine Schattner, MD

Last week, Pauline Chen wrote on medical ethics and clinical trials. She reflects on her training at a cancer research hospital, where some cancer patients go with unrealistic optimism.

Like Dr. Chen, I spent part of my training at a famous cancer center where I worked as a resident and fellow on rotations. And yes, some patients were unreasonably optimistic and some – perhaps even most, it seemed – didn’t fully “get” the purpose of their trial, which in Phase I studies were not designed to help them. This is a real dilemma for treating oncologists.

Posted in clinical trials, Ideas, Informed Consent, Medical Ethics, Oncology (cancer), Patient AutonomyTagged clinical trials, informed consent, Lake Wobegon effect, optimism, Pauline Chen, prognosis2 Comments

Tennis News and Why a Healthy Young Woman Might Get a Pulmonary Embolism

March 3, 2011January 2, 2013 Elaine Schattner, MD

Yesterday I learned that Serena Williams, the tennis pro, has been treated for a pulmonary embolus. My husband found out this morning upon reading the newspaper. He wondered why this would happen to a strong, young, athletic woman. Without delving into the private or specific aspects of her case: A pulmonary embolism, or PE in […]

Posted in Hematology (blood), Medical News, Public Illness, Women's HealthTagged blood clot, clotting disposition, DVT, hematology, hypercoaguable state, PE, pulmonary embolism, Serena Williams1 Comment

Learning About the Cancer Genome Atlas

March 2, 2011May 28, 2012 Elaine Schattner, MD

A tweet from a former research colleague reminded me about the Cancer Genome Atlas, which I’d been meaning to check out. This website covers a project jointly funded by two NIH institutes: the NCI and the National Human Genome Research Institute (NHGRI). The project is about documenting cancer genetics for many, many human tumors. Some […]

Posted in Genetics, Medical Education, Oncology (cancer), Science, Wednesday Web SightingTagged cancer genetics, Cancer Genome Atlas, cancer mutations, NHGRI, targeted therapyLeave a Comment

Breast Cancer Rate in the U.S. is No Longer Declining

February 28, 2011March 2, 2011 Elaine Schattner, MD

A worrisome report on breast cancer trends in the U.S. appeared on-line today, ahead of print in an AACR journal, Cancer Epidemiology, Biomarkers & Prevention. The analysis, based on the NCI’s SEER data from 2000 – 2007, shows that the incidence of breast cancer in the U.S. is no longer declining. (A drop after 2002 […]

Posted in Breast Cancer, Epidemiology, Medical News, Oncology (cancer)Tagged breast cancer ages 40-49, breast cancer rates in U.S., breast cancer screening, ER+ tumors, mammography math, SEER data, Women's HealthLeave a Comment

A Video About a Robot and a Patient

February 28, 2011May 28, 2012 Elaine Schattner, MD

Since Watson won on Jeopardy, there’s been lots of talk of robots assuming doctors’ roles. Ten years into our future, machines with programmed empathy and nuanced diagnostic skills will solve diagnostic dilemmas, deduce optimal treatment and make us well. Yesterday I found a new Xtranormal video, this one crafted by Dr. Charles of his excellent […]

Posted in Communication, Future of Medicine, Health IT, Patient-Doctor Relationship, Social Media, VideoTagged artificial intelligence, doctor-patient relationship, doctors like robots, health IT, humanism in medicine, WatsonLeave a Comment

Radiologists’ Experience Matters in Mammography Outcomes

February 24, 2011July 13, 2016 Elaine Schattner, MD

There’s a new study out on mammography with important implications for breast cancer screening. The main result is that when radiologists review more mammograms per year, the rate of false positives declines. The stated purpose of the research,* published in the journal Radiology, was to see how radiologists’ interpretive volume – essentially the number of […]

Posted in Breast Cancer, cancer screening, Diagnosis, health care delivery, Oncology (cancer), Under the RadarTagged breast cancer screening, Breast Cancer Surveillance Consortium, false positives, mammography, radiology, telemedicine, value of expertise, Women's Health8 Comments

A Vitamin Chart From the National Women’s Health Information Center

February 23, 2011May 28, 2012 Elaine Schattner, MD

Lately I’ve been worrying about Kevin’s refusal to eat broccoli, and wondering what exactly is so good about those green bunches of roughage. In browsing the Web for more detailed information on the matter, I found a helpful vitamin chart.

This table comes from the HHS-sponsored National Women’s Health Information Center – a good spot to know of if you’re a woman looking on-line for reliable sources. It’s a bit simple for my taste. In the intro, we’re told there are 13 essential vitamins our bodies need. After some basics on Vitamin A – good for the eyes and skin, as you probably knew already – the chart picks up with a quick review of the essential B vitamins 1,2,3,5,6, 9 and 12 (my favorite), followed by a rundown on Vitamins C, D, E, H (that would be biotin) and K:

Posted in Homemaking, Nutrition, Wednesday Web SightingTagged broccoli, cooking, National Women's Health Information Center, nutrition, Public Health, vitamins3 Comments

May I Call You ‘Doctor’?

February 22, 2011December 8, 2012 Elaine Schattner, MD

Last week I considered the relationship between the Prince Albert and his speech therapist in The King’s Speech. One aspect I wanted to explore further is why the future king initially insisted on calling the practitioner “doctor.” In real life, now, patient-doctor relationships can be topsy-turvy. This change comes partly a function of a greater […]

Posted in Communication, Empowered Patient, Life as a Doctor, Life as a Patient, Movies, Patient-Doctor RelationshipTagged call me doctor, doctor term, doctor-patient relationship, first-name basis, how to refer to a physician, movie, patient-doctor relationship, respect for physicians, the King's speech2 Comments

New Numbers Should Factor Into the Mammography Equation

February 21, 2011February 24, 2011 Elaine Schattner, MD

On Friday the New York Times reported that surgeons are performing far too many open breast biopsies to evaluate abnormal mammogram results. A new American Journal of Surgery article analyzed data for 172,342 outpatient breast biopsies in the state of Florida. The main finding is that between 2003 and 2008, surgeons performed open biopsies in an operating room – as opposed to less invasive, safer biopsies with needles – in 30 percent of women with abnormal breast images.

I was truly surprised by this should-be outdated statistic, which further tips the mammography math equation in favor or screening.

Posted in Breast Cancer, cancer screening, health care costs, Medical News, Oncology (cancer)Tagged breast biopsy, breast cancer screening, health care costs, mammography, mammography math, needle biopsies, outdated medical practice, surgical biopsyLeave a Comment

Stunning Comments on the Risk of Breast Implants, and Cancer

February 18, 2011May 28, 2012 Elaine Schattner, MD

The FDA recently identified a link between breast implants and a rare form of lymphoma. From today’s report in the New York Times: When talking to patients about a rare type of cancer linked to breast implants, plastic surgeons should call it “a condition” and avoid using the words cancer, tumor, disease or malignancy, the […]

Posted in Breast Cancer, Communication, Informed Consent, language, Oncology (cancer), Patient Autonomy, Plastic and Reconstructive SurgeryTagged anaplastic large cell lymphoma, breast implants, cancer terms, communication in medicine, fear of cancer, informed consent, lymphoma, Oncology (cancer), reconstructive surgeryLeave a Comment

A Glimpse into the Cochrane Library

February 16, 2011February 16, 2011 Elaine Schattner, MD

I’m taking notes on the Cochrane Library. The site – a collection of databases and reviews – drew my attention yesterday when an embargo was breached for an article to be published there having to do with zinc’s putative power to squelch the common cold. From the website, published John Wiley & Sons, Ltd.: the […]

Posted in Epidemiology, Medical History, Wednesday Web SightingTagged Cochrane Collaboration, Cochrane Library, Cochrane Reviews, library, medical information, Professor Archibald Leman Cochrane, Web resourceLeave a Comment

The King’s Speech is Not Just About Stuttering

February 14, 2011May 28, 2012 Elaine Schattner, MD

Over the weekend I went to see the King’s Speech. So far the film, featuring Colin Firth as a soon-to-be-King-of-England with a speech impediment, and Geoffrey Rush as his ill-credentialed but trusted speech therapist, has earned top critics’ awards and 12 Oscar nominations. This is a movie that’s hard not to like for one reason […]

Posted in Communication, Medical History, Movies, Patient-Doctor Relationship, ReviewsTagged cigarettes, Colin Firth, credentials, doctor-patient relationship, Geoffrey Rush, movie, review, speech therapy, stuttering, the King's speech, trust2 Comments

More News On Lymph Nodes and Breast Cancer Surgery

February 10, 2011February 13, 2011 Elaine Schattner, MD

Last week the New England Journal of Medicine (NEJM) printed a major research article on lymph node dissection in breast cancer surgery. When I first saw the Times’ recent headline, I thought it would cover this paper: Effect of Occult Metastases on Survival in Node-Negative Breast Cancer.*

It turns out there were separate articles on axillary node dissection after sentinel node biopsy in breast cancer – one in JAMA and one in the NEJM – published a week apart. For some reason, the NEJM paper got little attention…

Posted in Breast Cancer, cancer treatment, Oncology (cancer), Pathology, Under the RadarTagged Breast Cancer, lymph nodes, metastases, occult mets, prognosis, sentinel node dissection, surgery, treatment options, Women's HealthLeave a Comment

Breast Cancer Study Shows No Benefit In Extensive Lymph Node Removal

February 9, 2011February 11, 2011 Elaine Schattner, MD

Today’s Times leads with a story on surgical removal of lymph nodes in women with breast cancer. The dramatic digital headline, Lymph Node Study Shakes Pillar of Breast Cancer Care, made me tremble at first glance. The article by Denise Grady covers a new report* in the Journal of the American Medical Association (JAMA).

The key finding is that for women with apparently limited disease before surgery who undergo subsequent radiation and chemotherapy, taking out all the cancerous nodes from the axilla (armpit) has no advantage.

I read the original publication and took some notes:

Posted in Breast Cancer, cancer treatment, Medical News, Oncology (cancer)Tagged axillary lymph nodes, Breast Cancer, lymphedema, prognosis, sentinel node dissection, surgical treatment, survivalLeave a Comment

Contemplating Diet and Nutrition: A First Look at the USDA’s New Guidelines

February 6, 2011May 28, 2012 Elaine Schattner, MD

On Sunday afternoons I tend to think about food for my family. Sometimes that’s because we’re having a few more than usual at the dinner table. Also, it’s a time when I order the bulk of fish, meat, produce and other ingredients for the week ahead. Since I had cancer, I’ve paid much more attention […]

Posted in Homemaking, Life, Medical News, NutritionTagged cooking, family meals, food, homemaking, nutrition, USDA, USDA 2010 report, USDA guidelines, vitamins2 Comments

Doctors Enjoy Smoking Camels, in an Old Cigarette Ad

February 4, 2011May 28, 2012 Elaine Schattner, MD

A new Twitter follow led me to LongartsZwolle, a blog by a pulmonologist in the Netherlands. A February 1 post needs no translation: More Doctors Smoke Camels Than Any Other Cigarette The clip is said, on YouTube, to be a 1949 commercial for Camel cigarettes. I tried to find more on this, first by clicking […]

Posted in Communication, Public Health, Social Media, VideoTagged Camel cigarettes, doctors smoke Camels, doctors smoking Camels, doctors' lives, R.J. Reynolds, smoking, tobacco, TV ads, YouTubeLeave a Comment

A New Twist on Peanut Allergies and Other Allergic Reactions

February 3, 2011May 28, 2012 Elaine Schattner, MD

The current New Yorker unfolds an engaging story on childhood food allergies. As related by Dr. Jerome Groopman, there’s a shift in how some doctors think about how these conditions are best managed and, even better – might be prevented. The article feeds into the recent discussion that medical science, and even dogma, too-often turns […]

Posted in Allergy, Magazine, Medical NewsTagged Bamba, childhood allergies, food allergies, Jerome Groopman, LEAP study, medical science, peanut allergies, the New YorkerLeave a Comment

Discovering Google’s Art Project

February 2, 2011May 28, 2012 Elaine Schattner, MD

Today’s Wednesday web sighting ranks high in awesomeness. I discovered Google’s Art Project through molecular biologist Jessica Palmer’s always-gorgeous Biophemera blog. The find is Google Art: I couldn’t make up my mind which image to capture for this post. So take a break and explore some of the world’s finest art collections, right at your […]

Posted in Exhibits, Life, Social Media, Wednesday Web SightingTagged art history, Battle of the Nile, De Loutherbourg, Google art project1 Comment

Considering the Significance of a Doctor’s White Coat

February 1, 2011March 28, 2019 Elaine Schattner, MD

A while back, a first-year med student asked me if I think physicians should wear white coats. There’s a debate about it, she mentioned. Indeed, in the spring of 2009 the AMA considered an unenforceable mandate that physicians in the U.S. not wear white coats. The news was getting around that doctors spread infection from […]

Posted in Essential Lessons, Life as a Doctor, Patient-Doctor RelationshipTagged doctors, hygiene, life as a doctor, patient-doctor relationship, physicians, professionalism, white coats9 Comments

An Oncologist Considers Rare Lymphomas in Women With Breast Implants

January 28, 2011February 23, 2011 Elaine Schattner, MD

I have to admit that when I first read about the FDA’s report tying rare cases of anaplastic large cell lymphoma to breast implants, my mind raced with a strange blend of excitement, intense interest and concern. My thoughts shifted from “wow, that’s really interesting” to “exactly what did the FDA find” to “should I be worried?”

So I’ve decided to write this morning’s post from my perspective as an oncologist

Posted in Breast Cancer, cancer treatment, Informed Consent, Medical News, Pathology, Plastic and Reconstructive Surgery, Women's HealthTagged ALCL, ALK, anaplastic large cell lymphoma, anaplastic lymphoma, breast implants, CD30, immunology, implant risks, lymphoma, reconstructive surgeryLeave a Comment

Medical Lessons