Blood and Hip Surgery: New Study Supports Fewer Transfusions

Under the radar, over the holiday week, the NEJM published a report on transfusion requirements in older adults who surgical hip repair. The main finding is that most patients, including the elderly and those at risk for cardiac complications of the procedure, don’t benefit from getting so many red blood cell transfusions as is commonly […]

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Thoughts on the Death of Amy Winehouse

I feel compelled to write at least a short note on Amy Winehouse, a young woman who was found dead in her London apartment a few days ago. I don’t like to speak ill of the dead, but the truth is I was never a big fan of her music. I wasn’t fond of her […]

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The Trouble With Placebos

The latest NEJM features a big story about a small trial, with only 39 patients in the end, on the potential for placebos to relieve patients’ experience of symptoms. This follows other recent reports on the subjective effectiveness of pseudo-pharmacology. My point for today is that placebos are problematic in health care with few exceptions. First, […]

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Looking Back on ‘The Normal Heart,’ and Patients’ Activisim

They were impatient with the pace of research and physicians’ protocols, and spoke out emphatically about their needs: for more research; for prevention and treatment; for easier access to new drugs; and, simply, for good medical care.

Posted in Empowered Patient, Essential Lessons, Infectious Disease, Life as a Patient, Reviews, TheaterTagged , , , , , , , , , Leave a Comment on Looking Back on ‘The Normal Heart,’ and Patients’ Activisim

What’s Next on the Big C? (Hopefully a Second Opinion)

(Hopefully a second opinion) When I last wrote on The Big C, a Showtime series in which the actress Laura Linney portrays a woman in her forties with advanced melanoma, I considered some of the options she might choose when the series resumes next Monday night. At the end of Season 1, she elected to […]

Posted in cancer treatment, Communication, Empowered Patient, Oncology (cancer), TV, Women's HealthTagged , , , , , , , , , 1 Comment on What’s Next on the Big C? (Hopefully a Second Opinion)

Shoutout: This Week’s Grand Rounds Hosted by the Prepared Patient Forum

Yesterday’s medical-blog Grand Rounds, on What it Takes, is hosted by the Prepared Patient Forum. There’s a nice array of diverse posts. Among my favorites this week are from patients’ perspectives: by Warm Socks, on complex and simple physical systems for remembering to take pills and by Heart Sisters, on ditching the bucket list. I […]

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E-Patient Dave Explains What It Means to Be An E-Patient

Med-blog grand rounds this week is hosted by e-patient Dave, who is Dave deBronkart, a real man who was diagnosed with a renal cell (kidney) cancer a few years back. He’s a terrific speaker and an Internet friend. By coincidence I was searching for the definition of an e-patient, and came upon it there, in […]

Posted in Communication, Empowered Patient, Health IT, Patient Autonomy, Patient-Doctor Relationship, Social Media, Video, Wednesday Web SightingTagged , , , , , , Leave a Comment on E-Patient Dave Explains What It Means to Be An E-Patient

Sad Stats for Science Knowledge in U.S. Schools

Today’s Times reports on our nation’s students’ poor science test results. The results are bleak: only 34% of fourth graders scored at a “proficient” level or higher; just 30% of eight graders scored at a proficient level or higher; 21% of twelfth graders scored at a proficient or higher level in science. The mega-analysis, prepared […]

Posted in Empowered Patient, Future of Medicine, Informed Consent, Medical Education, Patient Autonomy, Public Health, ScienceTagged , , , , , , Leave a Comment on Sad Stats for Science Knowledge in U.S. Schools

On a Velázquez Portrait, and the Value of Expertise

This is an unusual entry into a discussion on the limits of patient empowerment. In late December the Times ran a story, beginning on its front page, about a portrait in the Metropolitan Museum of Art by Diego Velázquez, the 17th Century Spanish painter. The news was that the tall representation of the teenage Prince […]

Posted in Diagnosis, Empowered Patient, Exhibits, Life in NYC, Medical Education, Patient AutonomyTagged , , , , , , , Leave a Comment on On a Velázquez Portrait, and the Value of Expertise

The Author Chooses Not to Go to the Emergency Room

Yesterday the author of ML wasn’t feeling too well. She had (and has) what’s probably a recurrent bout of diverticulitis, a condition when a little pouch stemming from the colon becomes inflamed and causes pain and fever. This can be serious if infection of the colon’s wall progresses, or catastrophic if the colon ruptures. So […]

Posted in Ideas, Life, Life as a Patient, Patient AutonomyTagged , 2 Comments on The Author Chooses Not to Go to the Emergency Room

Does Cathy Make the Right Cancer Treatment Decision in the Big C?

“I don’t want to get sicker trying to get better and then just end up dying anyway” – Cathy, the 42 year old protagonist, with advanced melanoma, on the Big C.

Spoiler alert: Don’t read this post if you don’t want to know what happens to Cathy in the Big C…After months of unusual and comfort zone-breaking behavior, Cathy

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Why I Went for My Screening Mammogram

I was afraid to get a mammogram because I didn’t want to learn I had cancer….I feared having a “false positive,” and undergoing multiple tests to evaluate abnormal images that would turn out to be nothing…I didn’t have time for all that…

Posted in Breast Cancer, cancer screening, Essential Lessons, Life as a Doctor, Life as a Patient, Oncology (cancer), Women's HealthTagged , , , , , , , , Leave a Comment on Why I Went for My Screening Mammogram

On Patient Empowerment and Autonomy

…I think the answer is inherent in the goal of being engaged, and that has to do with the concept of patient autonomy – what’s essentially the capacity of a person to live and make decisions according to one’s own set of knowledge, goals and values.

Autonomy in medicine, which borders on the empowerment idea, can be an aim in itself, and therefore valuable regardless of any measured outcome.

Posted in Communication, Empowered Patient, Neurology, Patient Autonomy, Patient-Doctor Relationship, Social MediaTagged , , , , , , , , , 3 Comments on On Patient Empowerment and Autonomy

New NY State Law on Information for Women Undergoing Mastectomy

The reality is that many women, particularly poor women without newspapers or internet access in their homes, don’t know about any of this. They don’t know their insurance covers pretty much all of these options, by law. Now they will, or should as of Jan 1, 2011. Good. The other curiosity is that …

Posted in Breast Cancer, cancer treatment, Communication, Medical News, Patient Autonomy, Plastic and Reconstructive SurgeryTagged , , , , , , , 2 Comments on New NY State Law on Information for Women Undergoing Mastectomy

DNA Comes Home, or Maybe Not

Earlier this month employees at most of 7500 Walgreens pharmacies geared up to stock a new item on their shelves: a saliva sampler for personal genetic testing. On May 11, officials at Pathway Genomics, a San Diego-based biotech firm, announced they’d sell over-the-counter spit kits for around $25 through an arrangement with the retailer. A curious consumer could follow the simple package instructions and send their stuff in a plastic tube, provided in a handy box with pre-paid postage, for DNA analysis.

Posted in Diagnosis, Empowered Patient, Future of Medicine, Genetics, Medical Education, Medical News, ScienceTagged , , , , , , , 2 Comments on DNA Comes Home, or Maybe Not

Why Blog on OncotypeDx and BC Pathology?

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 , , , , , , , , 2 Comments on Why Blog on OncotypeDx and BC Pathology?

When ‘No’ Turns Positive in Medical Care and Education

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…

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Ten Ways to Better Our Health

(in the Style of a Magazine Cover)

If patients knew more:

1. they’d understand more of what doctors say;

2. they’d ask better questions;

3. they’d be more autonomous;

4. they’d make better decisions (ones they’re comfortable with, long-term);

5. they’d spend less money on care they don’t want or need.

If doctors knew more…

Posted in Communication, Empowered Patient, Patient-Doctor RelationshipTagged , , , , , 2 Comments on Ten Ways to Better Our Health

9 + 1 Ways to Reduce Health Care Costs

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 , , , , , , Leave a Comment on 9 + 1 Ways to Reduce Health Care Costs

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

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