Last week, I had the pleasure of giving a talk on cancer at the University of Iowa Carver College of Medicine Mini-Medical School, a series of presentations provided to the lay public to introduce them to a topic in medicine. Every time I give a talk to a lay audience, I think back to a wonderful woman I had as a patient when I was doing my oncology training in the 1980s. She was a retired English teacher who took pleasure in gently ribbing me about the words I selected when I spoke with her (once a teacher, always a teacher). I recall one time when I suggested we consider putting her “on trial.” Her response – “Put me on trial? What a strange phrase. I certainly wish getting cancer was against the law! Why do you want to put me on trial?” That lead to an animated conversation about not only that phrase, but how doctors use expressions when talking to each other that are interpreted differently by patients. While I don’t recall which additional specific phrases we discussed back then, that conversation had a long lasting effect on me, and the phrases I use when I speak to patients, families and the public.
Sometimes, progress brings uncertainty. The past few years have seen a steady increase in the number of drugs and other approaches to cancer treatment such as immunotherapy that can be used to treat cancer. Most of these new approaches do not cure cancer when given as a single therapy. Nevertheless, many of them are very effective at inducing a temporary shrinking of the cancer. For many cancers, we have a number of such treatments available. From a physician’s point of view, these new treatments create more options for patients. But they raise a question that cancer doctors have struggled with for decades. Do we … Continue reading
Several years ago, I made a “decision” that I needed to figure out a better way to make decisions.
We all struggle with decisions whether big or small. We all sometimes delay making difficult decisions, or revisit the decision once it is made again and again. For me, difficult decisions can vary from deciding what treatment to recommend for a cancer patient, to determining how best to structure a new cancer research program, to deciding whether I should attend yet another meeting. There are times when I feel overwhelmed by the sheer number, the potential consequences and the variety of decisions that need to be made, particularly if I put off the difficult ones and let them build up. Continue reading