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By Elaine Schattner, MD, on September 28th, 2011
 Dear Readers,
There’s so much I’d like to write on, but the Jewish new year begins in but a few hours. For the next few days I will be celebrating the holiday with my family and friends.
I wish all who celebrate a healthy and sweet new year.
To everyone else, enjoy these days!
–ES
honey at Texas State Fair (Wiki-Commons image)
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By Elaine Schattner, MD, on September 28th, 2011
Last night Showtime aired the second season’s finale of the Big C. As usual, there was no detail whatsoever about Cathy’s advanced melanoma or treatment.
I didn’t think the show could get worse, in the reality-of-having-cancer sense, but it did. Cathy, who still looks great and complains of no physical problems, determinately runs, walks and trudges through a New Year’s marathon. OK, that might happen, but it shouldn’t.
Biggest mistake ever in this series so far: In a scene near the end, Cathy’s first oncologist shows up at the race to see her meet the finish line. While they’re waiting, he and Cathy’s teenage son Adam go to a diner. Adam asks the doctor about his mom’s prognosis, and the oncologist answers.
It’s a blatant, medical ethics 101 no-no — talking to a patient’s family member without her permission. And to a minor, no less.
I just read the program has been renewed for a 3rd Season.
See more End of the Big C Season 2, ML Coverage Stops
By Elaine Schattner, MD, on September 27th, 2011
 I finally caught Contagion, a week or so after the movie spread to theaters throughout the country. After so much talk about the film’s scientific grounding, or not, I wasn’t sure what to expect of a film on such a scary and medically intense subject. And with so many star actors, and being directed by Steven Soderbergh, the work was bound to disappoint this doctor-writer-viewer.
The imaginary scare, grounded in science, offers little pleasure. I didn’t enjoy watching it much.
Still, there’s value in disseminating information on how germs spread. Other, expert writers have already covered ID aspects of the film, like details on a hybrid bat-pig virus infecting humans.
I might complain about the absurd blogger-villain, but let’s just say he’s not worth it.
My favorite scene is contained within the official movie’s trailer. In it, we see Matt Damon portraying the husband of a woman (Gwyneth Paltrow) who’s just returned from a business trip in Hong Kong with a cough and lethal virus.
See more In Shock, and Not Hearing What the Doctor Says in ‘Contagion’
By Elaine Schattner, MD, on September 26th, 2011
With little fanfare, the NEJM published a feature on breast cancer screening in its Sept 15 issue. The article, like other “vignettes” in the Journal, opens with a clinical scenario. This time, it’s a 42 year old woman who is considering first-time mammography.
The author, Dr. Ellen Warner, an oncologist at the University of Toronto, takes opportunity to review updated evidence and recommendations for screening women at average risk for the disease. She outlines the problem:
Worldwide, breast cancer is now the most common cancer diagnosed in women and is the leading cause of deaths from cancer among women, with approximately 1.3 million new cases and an estimated 458,000 deaths reported in 2008.(1)
On screening:
The decision to screen either a particular population or a specific patient for a disease involves weighing benefits against costs. In the case of breast-cancer screening, the most important benefits are a reduction in the risk of death and the number of
See more NEJM Publishes New Review on Breast Cancer Screening
By Elaine Schattner, MD, on September 22nd, 2011
In the city where I live, it’s hard to buy a muffin at a Starbucks without stepping back from the counter and reconsidering. Swallowing 460 calories for a minimal-nutrient breakfast seems foolish.
So I eat fewer muffins than I used to. The posted nutritional tidbits, however imprecise, on the contents of pieces of quiche, slices of pizza and cups of thick soup, stick with me when I travel, and at home.
That’s me, just n=1.
Yesterday the mayor gave a speech at the U.N. He’s quoted in today’s WSJ health blog:
In a speech to the U.N. General Assembly earlier this week, Mayor Michael Bloomberg rattled off New York’s achievements: a tough anti-tobacco campaign that made cigarettes, at about $11.20 a pack, the most expensive in the nation and led to a reduction in adult smoking rates to 14% in 2010 from 22% in 2002 (the national rate is 19.3%). A ban on artificial trans fats. Calorie labeling in restaurants. Ad campaigns linking soda consumption to obesity, and a national
See more New York City Mayor Bloomberg Promotes Healthy Lifestyle Choices
By Elaine Schattner, MD, on September 21st, 2011
Dr. Anne Marie Cunningham is a GP who lectures at the University in Cardiff and practices in South Wales. She’s been blogging on Wishful Thinking in Medical Education since October, 2008.
We connected on-line a while back, likely a function of shared interests, but it took me a while to examine her work. It’s rich with ideas on ethics, technology and teaching modern medicine.
The UK’s Telegraph picked up on a recent, excellent post, Social media, black humor and professionals…
There’s a lot I might learn by following ‘Wishful Thinking…,’ and will.
—
Addendum 10/3/11: links corrected.
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By Elaine Schattner, MD, on September 20th, 2011
I stayed up last night watching the Big C. The latest episode, The Darkest Day, takes place on Dec 21 at the end of the show’s pseudo-fall second season.
Here, two things happen of above-average interest to this doctor-patient-viewer:
First, the characters’ usual and crude shenanigans are interrupted by Cathy’s visit to a class of future cancer doctors. (Can we say “oncologists”? No, it’s too big a word for this program.)
Second, Cathy aborts her family’s planned vacation to stay with her friend Lee, who’s dying. Her decision to stay with Lee is perhaps the most interesting, and controversial, decision she’s made so far, but I won’t harp on this, because how can anyone judge what she’s doing?
The lecture scene:
Dr. Sherman (Alan Alda) “presents” Cathy (Laura Linney) to his class, a group of diverse young people most of whom are taking notes on (Apple – another story) laptops in a small lecture style room. The
See more Cathy Tells Future Cancer Docs to Shut their Laptops and Speak Plainly
By Elaine Schattner, MD, on September 19th, 2011
Today I visited my internist for a checkup and flu shot. We talked about how I’m doing, and she examined me, and we discussed what procedures I ought have done and not done. She’s been my doctor since the summer of 1987, when I was an intern at the hospital.
We reviewed so much that has happened in the interim.
How rare it is, now, to have a doctor who knows me. Continuity in care is so valuable.
One of my greatest fears is being in the hospital again, and having hospitalists – doctors who work full-time in the hospital – be the ones to see me each day, and make decisions about what I need. Yet I’m bracing for it because, well, that’s how it is, now.
From a health care administration perspective, I recognize the value of delegating inpatient care to physicians who are not my usual doctors. And from the perspective of a physician who after hours
See more The Immeasurable Value of Continuity of Care
By Elaine Schattner, MD, on September 18th, 2011
The Mayo Clinic’s blog offers an unusual idea for a wedding gift registry: health care.
In This Bride Wants to Register at the Mayo Clinic, author Meredith Gould half-jokingly writes:
My Bridal Registry wish list includes (in priority order): comprehensive blood work and urine analysis; a mammogram, pap smear, and DEXA scan; a complete eye exam by an ophthalmologist; an EKG and echo-cardiogram; and an MRI of my lower spine and X-rays of both knees.
Details aside (not all components of the author’s list, on a platform sponsored by a mega-hospital system, are essential in what would be mine), this is a brilliant idea!
And while we’re thinking in this mode: how about vaccinations for kids? (baby shower) and well visits for adults (anniversaries).
#SignsOfTheTimes
h/t Dawn McKinney, @napernurse
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By Elaine Schattner, MD, on September 16th, 2011
A post in yesterday’s Well column, about coverage of breast cancer by the media, focused on the first-person narrative of NBC’s Andrea Mitchell. Journalist Tara Parker-Pope writes:
Her announcement has generated much discussion in the blogosphere, including an analysis by Gary Schwitzer, publisher of HealthNewsReview.org, who writes that Ms. Mitchell made some missteps in discussing her cancer.
The Times column goes on to consider what was said, and how it might have been said better, and I agree with much of it. But mainly it’s a meta discussion, journalists talking about how other journalists consider breast cancer facts, figures and narratives.
Buried deep is this number, that according to the NCI, one in 69, or for the sake of simplicity – approximately 1 in 70 — women in the U.S. will receive a diagnosis of BC in her forties.
That is an astonishingly enormous proportion of women under 50 years affected by a devastating disease.
—
See more 1 in 70 Women Develops Breast Cancer Before Reaching 50 Years
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