I can’t tell you the number of people who complain to me about having their hope taken away. Exactly what this means, though, isn’t always clear.
Sometimes an oncologist will tell them (so they say) that they have a month to live. Sometimes their cardiologist tells them (so they say) not to travel to their grandson’s Bar Mitzvah. Sometimes the spine surgeon tells them their back will always hurt, no matter what. So they say.
Patients tell me a lot of things. I’m not always sure what other doctors really told them, but what is important is what the patient heard. The oncologist might have said “incurable” but followed it up by “but treatable for years.” I suspect after hearing “incurable”, not much else gets in.
One thing I’ve finally learned after a number of years is that patients actually listen, even if you don’t think they do. What they hear is a different story. Depending on their mood and circumstance, they may hang on single phrases, subtle inflection, the way your eyes dart.
To be an effective physician, you must also be an actor of sorts; not in the sense of pretense, but in the way you pay attention to everything your words and body do, and how your audience reacts.
I had a patient a few years back, a very pleasant older woman, who came to me with difficulty in swallowing. There can be a number of different reasons for this. A radiographic study, however, showed a lesion in her esophagus that was almost certainly cancer. Normally, I won’t speak on the phone to people about such things, but she and I had decided for various reasons that this would be the best way to communicate. I told her about the results:
Continue reading “Never say “hopeless””
I recently lost a close family member to cancer. She was old, she had been ill a long time; it still hurts. But in her dying, she made some wise choices. She was a very bright woman, and retained her mental capacities right up until the end. This gave her the opportunity to decide how she would approach death. She chose to enroll in hospice.
Hospice is widely misunderstood, partly because of the way we misunderstand death in the U.S. Instead of an inevitable part of life, death here is seen as an enemy to be fought at all costs, no matter the futility. Intensive care units, which were designed to care for people with a severe but potentially curable illness are full of the incurable—people on ventilators who will never breathe on their own again, who will never have a significant interpersonal interaction again.
Continue reading “Why hospice matters”
I’m not going to lie to you. This post contains some actual science. WAIT! Don’t click away! I’ll make it palatable, I promise!
It’s just that this is such an interesting story, and I can’t help sharing it. It is a shining example of one of the great successes of modern medical science, and stands in such stark contrast to the unfulfilled promises of the cult medicine crowd, with their colon cleanses and magic pills. This is the story of a real magic pill.
Continue reading “Try and beat this one, alties!”
I’ve mentioned before that I think that PBS stations are making a deal with the devil when they feature Gary Null’s infomercials. This alternative medince guru is a classic crank—an HIV denialist, seller of phonie cures, and host to other cranks.
But at least he’s a nice guy, right?
Ask Lee Phillips, some guy who decided to call out his local public radio station. He wrote a very good letter to WPFW to complain about their hosting of an alleged snake-oil salesmean. In a rather creepy turn of events, the station, rather than pen a response, sent his letter on to Null’s representative(s), who basically threatened to sue him. Lee, being a diligent crank-buster, wrote back (and don’t forget to take Lee’s advice about googling the guy…it’s worth it).
Anyway, apparently Lee got a chance to debate Null on the air, and hopefully he’ll inculde a link to it in a comment.
This is priceless, really. But if cranks start actually suing people, things are going to get ugly. So much for “Dr.” Nice Guy.
OK, so it’s a repost from the old blog. I’m on vacation so gimme a break. –PalMD
When I get bored, I sift through the “articles” section of Gary Null’s site to see what kind of stupidity he is willing to host. Thankfully, it never takes long to find the stupid. This time, it was more on the so-called blood type diet. The article (not written by Null, just hosted on his site) is one of those wonderful oeuvres whose very title contains an unfounded assertion. Exposing falsehoods such as this may have its own benefits, but I would like to show how poor logic can easily lead to poor conclusions.
The assertion—that blood type and diet are related—is prima facie false and somewhat bizarre. It’s like saying eye color and urine volume are related—yes, both have to do with the human body, but what possible relationship could they have? On what basis should one assert this?
Continue reading “More inanity from our friend Null”
In this space, we have explored some real conspiracies, using as an example the tobacco companies’ war on truth. Smoking, and smoking-related disease, continues to be a significant burden on the health of Americans. For example, chronic obstructive pulmonary disease (COPD) affects between 10-25 million Americans. This disabling illness, which includes emphysema and chronic bronchitis, is horrifying to watch, and worse to experience. Smoking is also one of the strongest risks for heart disease which kills over half-a-million Americans yearly.
But it seems that smoking is on the decline, at least in my rarefied world of home/office/hospital. Even as I go to the coffee shops, book stores, and restaurants around town, I see very few smokers. So it was a shock when I arrived here in Key West on vacation that I found everyone smoking—not just at the bars and open air restaurants, but a huge number of people just walking down the street. What gives?
Continue reading “Who smokes?”
I’m vacationing, so I’ll point you to some important posts from my SciBlings, DM and Orac. Measles is no joke, and the latest report reminds us that the anti-vaccine folks are dangerous.
Stephanie Simon of the Journal reports today on what Sciencebloggers already know: that the creationists have shifted their tactics from focusing on activism on local school boards to pitching their cause to state legislators:
Their new tactic: Embrace lessons on evolution. In fact, insist students deserve to learn more — including classes that probe the theory for weakness. They believe — and their opponents agree — that this approach will prove more acceptable to the public and harder to challenge in court.
Those promoting the new bills emphasize that academic freedom doesn’t mean biology teachers can read aloud from the Book of Genesis. “This doesn’t bring religion into the classroom,” said Florida state Rep. D. Alan Hays, a Republican.
The bills typically restrict lessons to “scientific” criticism of evolution, or require that critiques be presented “in an objective manner,” or approved by a local school board.
And the polling numbers don’t look good.
Here, creationists have so much power because it seems as though most people simply don’t care about the issue. In that type of situation, a well organized, loud minority group can foist its policy agenda upon the public at large.
It would be interesting to see how much these groups really are committed to the principles of academic freedom. Would they support, for instance, a bill that allowed teachers to discuss sexual health and education without parental permission? Or one that “taught the debate” that masturbation is normal and healthy? One would quickly find that these groups don’t actually like freedom in the classroom, except when it comes to their pet subject.
Many of my fellow bloggers, and many fellow Michiganders, have noted a breath of fresh air out of (ironically) the Motor City. This quote from Real Detroit Weekly’s review of Expelled hits on an important point. By way of background, the following quote refers to the incident where biologist PZ Myers (who happens not to believe in any gods) was kicked out of a screening of the movie:
Mathis laughs before offering two reasons why he told the security guard at the screening not to let Myers in. First, Mathis says, “He has viciously attacked me personally and attacked the film.” Just to clarify, Myers did not break into Mr. Mathis’ house in a drunken rage with a bowie knife–he has simply been critical of Mathis’ arguments.
And here, my friends, is a chasm that may be too hard to cross, no matter how we frame the issue. When someone attacks, say, my belief that beta blockers prolong survival in heart failure, my response is, “Really? Prove it.” If they prove it, OK. If they don’t, OK (more or less). No hard feelings. When you tell a Creationist, “Your beliefs are not science, and should really stay out of the classroom,” they feel viciously attacked. Their “scientific” ideas aren’t scientific at all, but religious ideas to which they are emotionally attached. When you tell a Creationist that their beliefs aren’t science, you might as well be telling them that their god is dead. And that’s a problem.
Many religious people are scientists, and many scientists are religious. There is no inherent conflict. Humans are perfectly capable of holding multiple contradictory ideas simultaneously—unless they are a Creationist. For the religious extremists, there can only be one “truth” and to criticize it is to be worse than wrong, it is to be heretical, and we all know what they do to heretics…