Sunday, November 30, 2008

"How Doctors Think"

I love highlighters. And I adore those tiny sticky strips with which I mark interesting passages in the books I read. So imagine my delight when a well-known pharmaceutical company via their local sales rep gave me four highlighters, each with scores of matching sticky tabs bursting out the sides. Of course, all these freebie pens bore the branded name of an expensive, widely-advertised anti-depressant.

Before I get to my point here, let me assure you that these gifts in no way influenced my prescribing habits. The pens, in fact, were all dried-up and hopeless for highlighting, but that made me no less likely to dole out the drug. The tabs were all I could hope for, but I promise you I've written not one additional prescription based on my delight. My patients often do well on this med, and that makes me more likely to prescribe it. Many who love the mood boost stop taking it, however, due to intolerable side effects, and that makes me less likely to write for it.

So there's a little insight into how this doctor thinks, but what I'm really plugging here is Dr. Jerome Groopman's must-have book "How Doctors Think." I'm halfway through it, and pages read thus far bristle with my ill-gotten, dirty-drug-money sticky tabs, each one flagging a point I wish I'd made in a book I wish I'd written. Not only should doctors read this book to understand why we think the way we do or to change our cognitive strategies in useful ways, you and I as patients (or as people who love and support patients*) should pay close attention as well.

Regular readers know that I've spent more than a little time these past two years as a designated listener and an advocate for friends and family working their way through the medical maze. I've seen how my colleagues listen or don't, and how they arrive at outrageous conclusions...or good ones, and the ways in which doctor/patient interactions influence the outcomes. Dr. Groopman has lots to say on the subject; more to come in later posts.
*Two other excellent books that will help you become your own best advocate are Sick Girl Speaks and Pursued by a Bear.

Saturday, November 22, 2008

Geraniums for the common cold

Argh, it's starting already, the steady stream of the walking wounded with their steady stream of respiratory secretions. All of them sharing a small exam room with me, one after the other, and looking for relief for their common colds.

I want to shout to the waiting room, go home, rest, drink fluids, don't cough on me. I understand, however, that no one's got time to be sick, and they wouldn't be in my waiting room if they didn't feel awful. So I was interested to read in last month's Health magazine (it comes free with my morning paper subscription) that a South African geranium used early on in the course of a cold may shorten the illness by two days.

There's a host of studies supporting the efficacy of extract of Pelargonium sidiodes (EPs or essence of geranium). Doctors at the National Medical University in Kiev invited 206 cold victims down to the lab (but I'll bet they passed up the opportunity to get up close and personal in an exam room with these people). All the patients were assessed for their Cold Inventory Score (CIS)* intially and after treatment with EPs or some murky liquid placebo.

Darned if those dosed with the real botanical deal didn't blossom forth to health at double the rate of the control group by day five. And ten days into the illness, the experimental group was more than twice as likely to zero out on their CIS score compared to their phyto-free colleagues.

So who wants to try Umcka ColdCare? You can get it in Denver at Sunflower Market or Vitamin Cottage, or find a store near you online at Nature's Way and hook me up with your testimonial.
*The CIS is a fancy way to prove the obvious, namely that the person in front of you coughing, sneezing, and wiping a Rudolph Red nose has a cold. The researchers asked "Do you have nasal drainage, sore throat, nasal congestion, sneezing, scratchy throat, hoarseness, cough, headache, muscle aches, and fever?" They then computed the sum of symptom intensity differences (SSID) of the cold intensity score (CIS) from day one to day five. Don't ever think that there's no scientific method behind phytomedicinal research!

Saturday, November 15, 2008

Been there, done that?
Share your cancer advice

I asked one of my patients years ago about the best advice and the worst advice she'd received during her treatment for breast cancer. I don't even remember what she said was the best so horrified was I to hear that my advice was the worst.

I had told her she should consider quitting her job in order to deal with the upcoming treatment. I meant well; why spend energy on work when you will need all your inner resources to undergo chemotherapy and radiation? Now I know that 1) if you quit work you lose your insurance, and 2) ongoing work may provide a measure of satisfaction and normalcy to a life that has been transformed by a cancer diagnosis. I currently advise newly diagnosed patients to consider filling out paperwork to activate the Family Medical Leave Act so absences for treatment or side effects won't jeopardize their job.

I am collaborating with my friend and colleague Gail Harrison (who has been there/done that cancer journey) on a book for newly diagnosed cancer patients. Please consider sharing your stories if you have been down that road as well, or pass this questionnaire on to a friend or family member who has been through this experience.

Sunday, November 09, 2008

Getting a call back from the doc!

Just finished a week of testing for my nearest and dearest. Getting the results was a bit of a challenge, even when I pulled rank with the "This is Dr. Paley calling Dr. R. for test results" which presumably pushed pushy me to the head of the phone call line.

Here's an article I wrote several years ago on the subject. I'd love to hear your stories about getting through (or not) to your physician.

Friday, November 07, 2008

"Hands, touching hands...

Reaching out,
Touching me,
Touching you.
--Neil Diamond

Yech, maybe not. Consider this study out from the University of Colorado in Boulder.

Scientists in the ecology and evolutionary biology department there used gene sequencing techniques to check out the bacterial communities living on hands in the University community. Not only did your average student mitt carry around 150 different species of bacteria, left hands and right hands carried different species, coeds had a greater diversity of species than their male colleagues, and regular hand washing did not cut down on the wide spectrum of bacterial types.

Do we dare shake hands ever again, or just nod and smile with shaking hands when we meet another traveling petri dish on the road of life? Study co-author Rob Knight has this reassuring news for the shakers and movers amongst us: "The vast majority of bacteria are non-pathogenic, and some bacteria even protect against the spread of pathogens."

Thursday, November 06, 2008


Pt: I have a tickle in my throat, so I tried not breathing for a couple of hours.

(Seriously, he was perfectly serious).

Wednesday, November 05, 2008

"I need a breast biopsy..."

per the frantic e-mail on my desk, "but can't afford it. Can you order the new blood test instead/ how much will it cost?"

Argh, that dreaded phone call about the abnormal mammogram. I've gotten one as have many of my patients. Follow-up, at times, is simply a matter of additional mammographic views, maybe follow-up films in 3 or 6 months, perhaps an ultrasound. Radiologists are extremely cautious in their reports, often calling patients back for further imaging, and sometimes--insomnia city-- advising a biopsy.

I've read hundreds of abnormal and suspicious reports. Often, there is a 'vague rounded density' that turns out to be just the superimposed shadows of breast tissue heaped on breast tissue, all normal. Frequently, there are 'microcalcifications' that look benign but a short-term follow-up is ordered to assure the little flecks are stable and not increasing in number.

But... this lady's report said "highly suspicious" and "spiculated" and these are not hedge words but a near definite diagnosis of cancer. This is not a dink around with a brand new screening test sort of report, but a work out a payment plan and get that biopsy done report.

Tomorrow: What's up with this new screening test? I didn't know, so I looked it up.