Medical Education – Page 6

Why Blog on OncotypeDx and BC Pathology?

May 21, 2010May 26, 2011 Elaine Schattner M.D.

I can’t even begin to think of how much money this might save, besides sparing so many women from the messy business of infusions, temporary or semi-permanent IV catheters, prophylactic or sometimes urgent antibiotics, Neulasta injections, anti-nausea drugs, cardiac tests and then some occasional deaths in treatment from infection, bleeding or, later on, from late effects on the heart or not-so-rare secondary malignancies like leukemia. And hairpieces; we could see a dramatic decline in women with scarves and wigs.

Posted in Breast Cancer, cancer treatment, Communication, Diagnosis, Empowered Patient, health care costs, Informed Consent, Pathology, Patient AutonomyTagged adjuvant chemotherapy, Breast Cancer, early-stage breast cancer, empowered patient, health care costs, medical tests, oncology, Oncotype Dx, Pathology2 Comments

More News, and Considerations, on OncotypeDx

May 16, 2010December 4, 2010 Elaine Schattner M.D.

This week I’ve been reading about new developments in breast cancer (BC) pathology. At one level, progress is remarkable. In the 20 years since I began my oncology fellowship, BC science has advanced to the point that doctors can distinguish among cancer subtypes and, in principle, stratify cases according to patterns of genes expressed within […]

Posted in Breast Cancer, cancer treatment, clinical trials, Diagnosis, Informed Consent, Oncology (cancer), Pathology, Patient AutonomyTagged Breast Cancer, ER+, estrogen receptors, evidence-based medicine, gene profiling, node-negative, Oncotype Dx, Pathology, risk of recurrence, Women's HealthLeave a Comment

The Checklist and Future Culture of Medicine

May 10, 2010October 31, 2021 Elaine Schattner M.D.

…Poka-yoke, a Japanese term for rendering a repetitive process mistake-proof, is familiar to some business students and corporate executives. This concept, that simple strategies can reduce errors during very complex processes, is not the kind of thing most doctors pick up in med school. Rather, it remains foreign.

Posted in Future of Medicine, health care costs, health care delivery, Life as a Doctor, Medical Education, Policy, Public HealthTagged doctors' lives, Future of Medicine, health care costs, ICU care, infections, patient safety, Poka-yoke, Public Health, the checklist6 Comments

Uncertainty Rules (on Eyjafjallajokull, volatility and a patient’s prognosis)

April 20, 2010September 13, 2021 Elaine Schattner M.D.

As pretty much anyone traveling in Europe this week can tell you, it’s sometimes hard to know what will happen next. Volcanologists – the people most expert in this sort of matter – simply can’t predict what the spitfire at Eyjafjallajokull will do next.

It comes down to this: the volcano’s eruption could get better or it could get worse…

Posted in Communication, Diagnosis, Life, Life as a Patient, Oncology (cancer), ScienceTagged communicating in medicine, decisions, diagnosis, expertise, Eyjafjallajokull, geology, health, interpreting medical data, medical informationLeave a Comment

When ‘No’ Turns Positive in Medical Care and Education

April 18, 2010March 17, 2011 Elaine Schattner M.D.

The medical word of the month is a most definite “no.”

The word is featured, explicitly and/or conceptually, in recent opinions published in two of the world’s most established media platforms – the New York Times and the New England Journal of Medicine. Their combined message relates to a point I’ve made here and elsewhere, that if doctors would or could take the time to provide full and unbiased information to their patients, people might choose less care of their own good sense and free will.

Let’s start with David Leonhardt’s April 7 column, “In Medicine, The Power of No.” In this excellent essay…

Posted in Communication, health care costs, Medical Education, Patient Autonomy, PolicyTagged communicating in medicine, decisions, empowered patient, health care costs, medical education, medical information2 Comments

9 + 1 Ways to Reduce Health Care Costs

April 5, 2010January 15, 2012 Elaine Schattner M.D.

Recently in the Times’ “Patient Money” column, Lesley Alderman shared nine physicians’ views on how we might reduce our country’s health care mega-bill.

Here, I’ll review those comments, add my two cents to each, and then offer my suggestion (#10, last but not least!) regarding how I think we might reduce health medical costs in North America without compromising the quality of care doctors might provide.

The “answers” from…

Posted in Communication, Future of Medicine, health care costs, health care delivery, Ideas, Medical Education, Patient-Doctor Relationship, Policy, Public HealthTagged communicating in medicine, empowered patient, health, health care costs, medical education, medical tests, patient-doctor relationshipLeave a Comment

A Small Study Offers Insight On Breast Cancer Patients’ Capacity and Eagerness to Participate in Medical Decisions

March 15, 2010December 3, 2010 Elaine Schattner M.D.

Last week the journal Cancer published a small but noteworthy report on women’s experiences with a relatively new breast cancer decision tool called Oncotype DX. This lab-based technology, which has not received FDA approval, takes a piece of a woman’s tumor and, by measuring expression of 21 genes within, estimates the likelihood, or risk, that her tumor will recur.

As things stand, women who receive a breast cancer diagnosis face difficult decisions…

Posted in Breast Cancer, cancer survival, Communication, Diagnosis, Empowered Patient, Informed Consent, Oncology (cancer), Pathology, Patient Autonomy, Patient-Doctor Relationship, Statistics, Under the RadarTagged Breast Cancer, cancer medicine, cancer treatment, communicating in medicine, decisions, empowered patient, genomics, health, medical information, medical tests, Oncotype Dx5 Comments

Today’s Press on Targeted Therapy for Cancer

February 24, 2010February 28, 2010 Elaine Schattner M.D.

Today the NY Times printed the third part of Amy Harmon’s excellent feature on the ups and downs and promise of some clinical trials for cancer. The focus is on a new drug, PLX4032, some people with melanoma who chose to try this experimental agent, and the oncologists who prescribed it to them.

What I like about this story is that, besides offering some insight on the drug itself, it balances the patients’ and doctors’ perspectives; it explains why some people might elect to take a new medication in an early-stage clinical trial and why some physicians push for these protocols because they think it’s best for their patients.

And it provides a window into the world of academic medicine, where doctors’ collaborate among themselves and sometimes with corporations.

Here’s some of what I learned:

Posted in cancer treatment, clinical trials, Communication, Medical News, Oncology (cancer), ScienceTagged cancer medicine, clinical trials, communicating in medicine, decisions, health, medical news, melanoma, Oncology (cancer), patient-doctor relationship, PLX40321 Comment

On Precious

February 8, 2010October 31, 2021 Elaine Schattner M.D.

This is my first film review, if it is that.

I was tempted to write about Ethan Hawke, hematologist among vampires in Daybreakers, but gore’s not my favorite genre. A mainstream choice would have been Harrison Ford solving the enzyme deficiency of Pompe disease in Extraordinary Measures, but I didn’t get sucked in.

I chose Precious, instead. This luminous movie relates to the practice of medicine everyday, big-time.

Posted in Communication, Essential Lessons, Life, Life as a Patient, Life in NYC, Medical Education, Medical Ethics, Movies, Patient Autonomy, Reviews, Women's HealthTagged abuse, disability, empathy, health care disparities, life as a patient, movie, obesity, Precious, Precious the movie, review, Women's Health1 Comment

Henrietta’s Cells Speak

February 5, 2010September 13, 2021 Elaine Schattner M.D.

“One of the ways that I gained the trust of the family is that I gave them information.” (R. Skloot, a journalist, speaking about her interactions with Henrietta Lacks’ family, Columbia University, 2/2/10)

Posted in Books, Communication, Essential Lessons, Ideas, Informed Consent, Life as a Patient, Medical Education, Medical Ethics, Oncology (cancer), Patient Autonomy, Patient-Doctor Relationship, Privacy, Reviews, Science, Women's HealthTagged books, cancer research, cervical cancer, communicating in medicine, HeLa cells, Henrietta Lacks, Johns Hopkins, life as a patient, medical education, medical ethics, medical research, patient-doctor relationship, Women's Health1 Comment

Why Give Blood?

January 18, 2010September 13, 2021 Elaine Schattner M.D.

Giving blood is something that’s close to my heart. When I was 14 years old, I received seven units of packed red blood cells from strangers…

Today, thousands will donate blood to honor the birthday of Dr. Martin Luther King, Jr… The holiday presents, also, a special opportunity to gather much-needed registrants for the National Marrow Donor Registry…

Posted in Hematology (blood), Life, Life as a Patient, Medical Education, Medical History, Public HealthTagged blood cells, blood donation, bone marrow donation, bone marrow registry, community awareness, health, Hematology (blood), transfusion1 Comment

Skyping Medicine

January 8, 2010February 24, 2011 Elaine Schattner M.D.

Yesterday, Dr. Pauline Chen reported in the New York Times on virtual visits, a little-used approach for providing care to patients hundreds or thousands of miles apart from their physicians.

Telemedicine depends on satellite technology and data transfer. It’s a theoretical and possibly real health benefit of the World Wide Web, that giant, not-new-anymore health resource that’s transforming medicine in more ways than we know.

Posted in Communication, Diagnosis, Future of Medicine, Health IT, Patient-Doctor RelationshipTagged communicating in medicine, Future of Medicine, health, internet medicine, IT, med tech, patient-doctor relationship, physician shortage, technology, telemedicine1 Comment

Looking Ahead: 7 Cancer Topics for the Future

January 4, 2010October 30, 2013 Elaine Schattner M.D.

Here’s my short list, culled from newsworthy developments that might improve health, reduce costs of care and better patients’ lives between now and 2020, starting this year: 1. “Real” Alternative Medicine. By this I don’t mean infinitely-diluted homeopathic solutions sold in fancy bottles at high prices, but real remedies extracted from nature and sometimes ancient […]

Posted in Future of Medicine, Health IT, Oncology (cancer), Science, Selected TopicsTagged alternative medicine, cancer immunology, cancer treatment, chemotherapy, e-health, Future of Medicine, health, health care costs, internet medicine, IT, palliative care, pharma, technologyLeave a Comment

Why Medical Lessons?

December 31, 2009December 29, 2013 Elaine Schattner M.D.

One of the things I liked best about practicing medicine is that I was constantly learning.

Making rounds at seven in the morning on an oncology floor would be a chore if you didn’t get to examine and think and figure out what’s happening to a man with leukemia whose platelets are dangerously low, or whose lymphoma is responding to treatment but can’t take anymore medicine because of an intense, burn-like rash. You’d have to look stuff up, sort among clues

Posted in Communication, from the author, Ideas, Life, Life as a Doctor, Life as a Patient, Medical Education, Medical Ethics, Patient-Doctor RelationshipTagged being in the hospital, communicating in medicine, doctor-patient relationship, doctors' lives, empathy, health, life as a patient, medical education, scoliosis1 Comment

Looking Ahead on Breast Cancer Screening

December 31, 2009December 31, 2013 Elaine Schattner M.D.

The risks and costs of breast cancer screening are exaggerated and misrepresented in the recent news…. My conclusion is that rather than ditching a life-saving procedure that’s imperfect, we should make sure that all doctors and radiology facilities are up to snuff.

We need to distinguish between errors in the measurement (cancer or not) and errors in decisions that we – patients and doctors – make after upon detecting a premalignant or early-stage malignancy in a woman’s breast.

Posted in Breast Cancer, cancer screening, Diagnosis, health care costs, Oncology (cancer)Tagged Breast Cancer, DCIS, decisions, false positives, health care costs, LCIS, mammography, screening controversy, Women's HealthLeave a Comment

A Bit More on False Positives, Dec 2009, Part 1

December 29, 2009October 25, 2011 Elaine Schattner M.D.

Why bother, you might ask – wouldn’t it be easier to drop the subject?

“Make it go away,” sang Sheryl Crow on her radiation sessions.

I’ll answer as might a physician and board-certified oncologist who happens to be a BC survivor in her 40s: we need establish how often false positives lead, in current practice, to additional procedures and inappropriate treatment…These numbers matter. They’re essential to the claim that the risks of breast cancer screening outweigh the benefits.

Posted in Breast Cancer, cancer screening, health care costs, Medical News, Statistics, Women's HealthTagged Breast Cancer, cancer screening, false positives, health care costs, mammography, mammography math, medical news, screening controversy, statisticsLeave a Comment

Legitimate Concerns and Unfortunate Timing on Radiation from C.T. Scanning

December 15, 2009November 23, 2010 Elaine Schattner M.D.

The risks of radiation from CT scanning will almost certainly add to the current confusion and concerns about the risks of breast cancer screening.

Mammography differs from CT scanning in several important ways:

1. Mammograms involve much less radiation exposure than CT scans.
2. Mammography is well-regulated by the Food and Drug Administration (FDA) and other agencies. The Mammography Quality Standards Act (MQSA) requires…
3. Women who undergo screening mammograms can control when and where they get this procedure. Screening mammograms are elective by nature..

Posted in Breast Cancer, cancer screening, Diagnosis, Medical News, Oncology (cancer), Women's HealthTagged Breast Cancer, cancer screening, decisions, health, mammography, media on medicine, medical news, radiation risk, Women's HealthLeave a Comment

How Well Do You Really Want to Know the “Red Devil?”

December 11, 2009September 13, 2021 Elaine Schattner M.D.

I know what it’s like to get the “red devil” in the veins.

You can learn about Adriamycin, a name brand chemotherapy, on WebMD. Or, if you prefer, you can check on doxorubicin, the generic term, using MedlinePlus, a comprehensive and relatively reliable public venture put forth by the National Library of Medicine and National Institutes of Health. If you’re into organic chemistry, you might want to review the structure of 14-hydroxydaunomycin, an antibiotic and cancer therapy first described 40 years ago…

Posted in Breast Cancer, cancer treatment, Essential Lessons, Life as a Doctor, Life as a Patient, Medical Education, Oncology (cancer), Women's HealthTagged Breast Cancer, cancer medicine, cancer treatment, chemotherapy, communicating in medicine, decisions, health, life as a patient, medical education, Women's Health2 Comments

On Juno and Screening Test Stats

December 3, 2009November 23, 2010 Elaine Schattner M.D.

“Well, well” says the convenience store clerk. “Back for another test?”

“I think the first one was defective. The plus sign looks more like a division symbol, so I remain unconvinced,” states Juno the pregnant teenager.

“Third test today, mama-bear,” notes the clerk.

…”There it is. The little pink plus sign is so unholy,” Juno responds.

She’s pregnant, clearly, and she knows she is.

(see clip from Juno the movie*)

Think of how a statistician might consider Juno’s predicament…

Posted in cancer screening, Diagnosis, Medical Education, Movies, StatisticsTagged cancer screening, decisions, empowered patient, false positives, health, interpreting medical data, Juno's pregnancy test, medical education, medical tests, movie, sensitivity and specificity, statistics, Women's HealthLeave a Comment

A Note on False Positives

November 29, 2009December 4, 2010 Elaine Schattner

A colleague sent me an email about my math. You’re more or less right, he said, but you need to account for the false positives. I agree with him. (It’s true.) The problem is, among others, how to present those numbers in the press. Statistics don’t sell; still, an explanation is due. In my next […]

Posted in Medical News, StatisticsTagged false positives, statisticsLeave a Comment

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