You have metastatic cancer and must decide upon a chemotherapy. Here are your options, drawn from real clinical trial data. Chemo 1: Will increase your life expectancy from 12 to 15 months. Chemo 2: Increases your chance of being alive at one year by 12%. In other words, one out of every eight patients receiving…
Mammograms for breast cancer; the PSA blood test for prostate cancer; CT scans for lung cancer; and things like stool blood tests and colonoscopies for colon cancer. Each of these screening tests is designed to find cancers, or precancers, before they become symptomatic, the goal of early detection being to enable clinicians to eradicate growths…
They both had shoulder pain, persistent despite weeks of physical therapy. Both received MRI examinations at reputable radiology facilities, looking for things like rotator cuff tears, labral disruptions and other anatomical abnormalities. What was different was the price they paid for the MRI, with one patient paying $1000 more than the other. Welcome to the…
A friend of mine recently had a very sore throat. She knew how to manage her symptoms–lozenges, warm tea and the like. But she was worried she might have strep and would therefore need antibiotics. That should be a simple question to answer with a quick trip to the primary care clinic. Except that her…
A recent study of men with early-stage prostate cancer found no difference in 10-year death rates, regardless of whether their doctors actively monitored the cancers for signs of growth or eradicated the men’s cancers with surgery or radiation. What does this study mean for patients? Based on research we have conducted on prostate cancer decision-making,…
My father is 92 years old, and I am beginning to wonder whether the best thing for his health would be to stay away from doctors. That’s because well intentioned physicians often expose their elderly patients to harmful and unnecessary services out of habit. That’s certainly the message I absorbed after reading a recent issue…
It is notoriously difficult to change physician behavior. When it’s discovered that primary care physicians are, say, prescribing too few cholesterol pills or too many antibiotics, it will not be easy to change those behaviors. Physicians are strong-willed people, with lots of things competing for their attention and with many well ingrained habits. That’s why…
Patients often rely on physicians for information about their treatment alternatives. Unfortunately, that information is not always objective. Consider a man with early stage prostate cancer interested in surgical removal of his tumor, but uncertain whether it is better for the surgery to be performed with the help of robotic technology. He asks his surgeon…
Very interesting article in the Lancet recently, from the nudge unit in the United Kingdom. They give physicians feedback on how much they prescribed antibiotics compared to their peers, and found that such feedback reduced antibiotic prescriptions. I hope to see more of this work!
Here is a write-up of a talk I recently gave at the NIH. The topic is a good one, about doctors and decision making and all that crap. But the real importance of linking you to the story is to find out if you hate my sport coat as much as my wife does. It…