As you said, Theresa, much to digest in your most recent posting. The point about having humility is well taken, as even in this age of evidence-based practice, much of what we offer (with some exception) comes from consensus. And as you point out, that can change over time. The other benefit of humility is it keeps us grounded with patients, especially when we are having difficult treatment conversations; we can be open as to what we do and don't know about what therapies are available.
As to vaccines, I am a fan as well; I struggled when I was practicing to make sure that my patients obtained what they needed, even if that meant having challenging conversations with resistant individuals. Flu vaccine for smokers was the worst, to the point where one patient challenged me to guarantee that he'd have no side effects. I told him that I couldn't do that, as all treatments have a certain amount of risk, but that I would call him at his house this evening to make sure he was OK. He accepted this, took the shot, and later that evening, I called him at home. When he gruffly answered the phone asking who was calling, I replied that it was his doctor, checking to see if he was dead. We both had a laugh over that, and the next time he needed the vaccine, I do recall it was an easier process. One caution: I had to learn how to use humor carefully with patients, remembering that you needed to know your audience, never be condescending or smug, and always operate with gentle kindness.
Thank you for this story! Thank you also for pointing out the need for humility with patients. When we clinicians forget that it tends not to go well--a lesson I learned from hospice, where patients would do what they chose to do regardless of what we said. Being humble was the primary way I got people to try to follow our recommendations. I agree with you also about humor, and can remember one situation where I used it too soon--never again. It earned me a well-deserved dirty look and another occasion to reflect on the importance of humility. We're all imperfect so why not be honest about it. Care would be better as a result.
Wonderful column, Theresa! (And fantastic photo of you at the end!) It is so important to remain humble and willing to admit we’re wrong in all areas of life, but of course in medicine human lives are at stake. My brother narrowly missed having his tonsils removed when doctors discovered he had a mild clotting issue, which changed the risk-benefit calculation. But pretty much every relative in my parents’ generation had theirs out. Crazy!
Wow--what an amazing story. It's as if the risk-benefit calculation was "all benefit, no risk" until more research was done showing that routine tonsillectomies had downsides. I hate to say this, but maybe it was a good money-maker for pediatric surgeons, too. After all, little kids tend to be healthy and therefore aren't lucrative. Might be worth doing a little digging to discover more of the story.
Thank you, Theresa for your interesting newsletter and for sharing your experience with tamoxifen. I had a similar experience after my bone marrow transplant for AML leukemia. Several months after transplant, my doctor started me on gilteritnib for maintenance. It was a horrible drug causing elevated liver enzymes and severe muscle pains. I could not tolerate it so had to discontinue it. I just saw my doctor for a six-month check-up. He is wonderful. To his credit, he shared with me that recent studies indicated that this drug did not lead to a decrease in relapse. I am glad he shared this new information with me.
Oh my gosh--what a story! Thank you so much for sharing it here and kudos to your doctor for making it clear to you that you had not put yourself at risk, rather than seeing you as "difficult" and not deserving of an explanation. Now I'm thinking about that label "difficult. It seems obvious that most people would do whatever they could to prolong their lives, so if you stopped taking a medication that prevented a cancer recurrence due to side effects it would be for a good reason. Clinicians should make that their assumption--which brings me back to the idea of humility! I appreciate you writing.
❤️🙏
Thank you, Will!
As you said, Theresa, much to digest in your most recent posting. The point about having humility is well taken, as even in this age of evidence-based practice, much of what we offer (with some exception) comes from consensus. And as you point out, that can change over time. The other benefit of humility is it keeps us grounded with patients, especially when we are having difficult treatment conversations; we can be open as to what we do and don't know about what therapies are available.
As to vaccines, I am a fan as well; I struggled when I was practicing to make sure that my patients obtained what they needed, even if that meant having challenging conversations with resistant individuals. Flu vaccine for smokers was the worst, to the point where one patient challenged me to guarantee that he'd have no side effects. I told him that I couldn't do that, as all treatments have a certain amount of risk, but that I would call him at his house this evening to make sure he was OK. He accepted this, took the shot, and later that evening, I called him at home. When he gruffly answered the phone asking who was calling, I replied that it was his doctor, checking to see if he was dead. We both had a laugh over that, and the next time he needed the vaccine, I do recall it was an easier process. One caution: I had to learn how to use humor carefully with patients, remembering that you needed to know your audience, never be condescending or smug, and always operate with gentle kindness.
Thank you for this story! Thank you also for pointing out the need for humility with patients. When we clinicians forget that it tends not to go well--a lesson I learned from hospice, where patients would do what they chose to do regardless of what we said. Being humble was the primary way I got people to try to follow our recommendations. I agree with you also about humor, and can remember one situation where I used it too soon--never again. It earned me a well-deserved dirty look and another occasion to reflect on the importance of humility. We're all imperfect so why not be honest about it. Care would be better as a result.
Wonderful column, Theresa! (And fantastic photo of you at the end!) It is so important to remain humble and willing to admit we’re wrong in all areas of life, but of course in medicine human lives are at stake. My brother narrowly missed having his tonsils removed when doctors discovered he had a mild clotting issue, which changed the risk-benefit calculation. But pretty much every relative in my parents’ generation had theirs out. Crazy!
Wow--what an amazing story. It's as if the risk-benefit calculation was "all benefit, no risk" until more research was done showing that routine tonsillectomies had downsides. I hate to say this, but maybe it was a good money-maker for pediatric surgeons, too. After all, little kids tend to be healthy and therefore aren't lucrative. Might be worth doing a little digging to discover more of the story.
Thank you, Theresa for your interesting newsletter and for sharing your experience with tamoxifen. I had a similar experience after my bone marrow transplant for AML leukemia. Several months after transplant, my doctor started me on gilteritnib for maintenance. It was a horrible drug causing elevated liver enzymes and severe muscle pains. I could not tolerate it so had to discontinue it. I just saw my doctor for a six-month check-up. He is wonderful. To his credit, he shared with me that recent studies indicated that this drug did not lead to a decrease in relapse. I am glad he shared this new information with me.
Oh my gosh--what a story! Thank you so much for sharing it here and kudos to your doctor for making it clear to you that you had not put yourself at risk, rather than seeing you as "difficult" and not deserving of an explanation. Now I'm thinking about that label "difficult. It seems obvious that most people would do whatever they could to prolong their lives, so if you stopped taking a medication that prevented a cancer recurrence due to side effects it would be for a good reason. Clinicians should make that their assumption--which brings me back to the idea of humility! I appreciate you writing.
Thoughtful, heartfelt, and beneficial! Keep up the great work, Theresa.
Thanks so much! I've been slow to respond because I got zonked by the Covid vaccine. So it goes. I appreciate your enthusiasm. It helps.