Ideas – Page 9 – Medical Lessons

You’re Sick and I’m Not, Too Bad

February 16, 2010March 28, 2019 Elaine Schattner M.D.

“The insurance market as it works today basically slices and dices the population. It says, well you people with medical conditions, over here, and you people without them, over here…
– Jonathan Cohn, Editor of The New Republic, speaking on The Brian Lehrer Show, February 16, 2010*
—–
There’s a popular, partly true, sometimes useful and very dangerous notion that we can control our health. Maybe even fend off cancer.

I like the idea that we can make smart choices, eat sensible amounts of whole foods…

Posted in Essential Lessons, health care costs, Ideas, Medical Ethics, Policy, Public Health, RadioTagged chronic illness, empathy, health care costs, health care reform, health insurance, informed decisions, medical ethics, Public Health1 Comment

Health Care Costs, Communication and Informed Choices

February 12, 2010August 30, 2011 Elaine Schattner M.D.

For those of you who’ve been asleep for the past year: the health care costs conundrum remains unsolved. Our annual medical bills run in the neighborhood of $2.4 trillion and that number’s heading up. Reform, even in its watered-down, reddened form, has stalled.

Despite so much unending review of medical expenses – attributed variously to an unfit, aging population, expensive new cancer drugs, innovative procedures, insurance companies and big Pharma – there’s been surprisingly little consideration for patients’ preferences. What’s missing is a solid discussion of the type and extent of treatments people would want if they were sufficiently informed of their medical options and circumstances.

Maybe, if doctors would ask their adult patients how much care they really want, the price of health care would go down. That’s because many patients would choose less, at least in the way of technology, than their doctors prescribe. And more care.

What I’m talking about is the opposite of rationing. It’s about choosing.

Posted in cancer treatment, Communication, Empowered Patient, health care costs, Informed Consent, Medical Ethics, Patient AutonomyTagged cancer medicine, chemotherapy, communicating in medicine, decisions, doctor-patient relationship, empowered patient, end-of-life, life as a patient, palliative care1 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

Are Doctors Necessary?

February 2, 2010October 31, 2021 Elaine Schattner M.D.

Ten years ago, my colleagues and I squirmed in our swivel chairs when a few tech-savvy patients filed in bearing reams of articles they’d discovered, downloaded and printed for our perusal.

Some of us accepted these informational “gifts” warily, half-curious about what was out there and half-loathing the prospect of more reading. Quite a few complained about the changing informational dynamic between patients and their physicians, threatened by a perceived and perhaps real loss of control.

How a decade can make a difference. In 2008 over 140 million Americans…

Posted in Communication, Empowered Patient, Essential Lessons, Health IT, Life as a Doctor, Patient-Doctor Relationship, Public Health, Social MediaTagged communicating in medicine, decisions, doctor-patient relationship, doctors' lives, e-health, empowered patient, expertise, Future of Medicine, health, health data, internet medicine, IT, medical information, social mediaLeave a Comment

How to Avoid Death in the ICU

January 25, 2010September 13, 2021 Elaine Schattner M.D.

It was sometime in April, 1988. I was putting a line in an old man with end-stage kidney disease, cancer (maybe), heart failure, bacteria in his blood and no consciousness. Prince was on the radio, loud, by his bedside. If you could call it that – the uncomfortable, curtained compartment didn’t seem like a good place for resting.

Posted in cancer treatment, Communication, Empowered Patient, Essential Lessons, health care costs, Life as a Doctor, Medical Ethics, Palliative Care, Patient Autonomy, Patient-Doctor RelationshipTagged being in the hospital, communicating in medicine, community awareness, DNR order, DNR orders, doctor-patient relationship, doctors' lives, empowered patient, end-of-life, health, hospice care, intensive care, life as a patient, palliative care, patient-doctor relationship, Women's Health4 Comments

Moms Tweet About Blood and Cancer

January 10, 2010February 17, 2010 Elaine Schattner M.D.

This afternoon I found a Tweet from a colleague, a journalist who happens to be a mom in my community:

Tweet from SuSaw:
“RT @JenSinger: Hey, baby. What’s your blood type? Nothing against the Big Pink Machine… http://ow.ly/URkg

As a trained hematologist (blood doc), oncologist and breast cancer survivor, I couldn’t resist checking this out. Here’s what I discovered…

Posted in Communication, Future of Medicine, Health IT, Hematology (blood), Social Media, Women's HealthTagged blood cells, blood donation, communicating in medicine, community awareness, Facebook, health, lymphoma, medical information, social media, Twitter, Women's Health1 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

Information Overload

December 21, 2009January 9, 2011 Elaine Schattner M.D.

Last week I received an email from a former patient. He has hemochromatosis, an inherited disposition to iron overload. His body is programmed to take in excessive amounts of iron, which then might deposit in the liver, glands, heart and skin. He mentioned “some amazing videos on hematology and hemochromatosis and genetics” he’d discovered on YouTube.

This is the future of medicine, I realized. … Whether physicians want their patients to search the Internet for medical advice is beside the point. We’re there already, whether or not it’s good for us and whether what we find there is true.

Posted in Communication, Empowered Patient, Future of Medicine, Health IT, Hematology (blood), Social MediaTagged decisions, expertise, Future of Medicine, health, health data, hemochromatosis, interpreting medical data, IT, media on medicine, medical information, medical news, patient-doctor relationshipLeave a Comment

Dinner with my Family

November 25, 2009May 25, 2012 Elaine Schattner, MD

Family gatherings centered on two things – food, and talk about medicine. We spoke of interesting cases (always nameless), challenging conditions and, even back then, the constraints of health care costs. My fiancé, now husband of over 20 years, couldn’t get over how debate over health care dominated our Rosh Hashanah and Thanksgiving feasts…

…when I learned I had breast cancer, I knew exactly what to do. The decisions, though difficult, were almost straightforward, buttressed by my knowledge and familiarity with the language of medicine…

Posted in Communication, Empowered Patient, Life as a Doctor, Life as a Patient, Medical Education, Patient-Doctor RelationshipTagged Breast Cancer, communicating in medicine, decisions, doctors' lives, health, medical education5 Comments

Getting the Math on Mammograms

November 20, 2009July 20, 2011 Elaine Schattner M.D.

But consider – if the expert panel’s numbers are off just a bit, by as little as one or two more lives saved per 1904 women screened, the insurers could make a profit!

By my calculation, if one additional woman at a cost of, say, $1 million, is saved among the screening group, the provider might break even. And if three women in the group are saved by the procedure, the decision gets easier…

Now, imagine the technology has advanced, ever so slightly, that another four or five women are saved among the screening lot.

How could anyone, even with a profit motive, elect not to screen those 2000 women?

Posted in Breast Cancer, cancer screening, cancer treatment, Diagnosis, health care costs, Medical Ethics, Medical News, Policy, Women's HealthTagged Breast Cancer, breast cancer screening, cancer screening, health care costs, mammography, mammography math, screening controversy1 Comment

Medical Lessons