1/6. Discussing disease progression and end-of-life decisions.Because most patients now want to know the truth about their diagnosis and prognosis, the ability to discuss the cancer diagnosis, disease recurrence, or treatment failure, and to solicit patients' views about resuscitation or hospice care, are important verbal skills for oncologists and other oncology health care providers. Moreover, the ability to clearly articulate a treatment plan or elicit patient preferences for treatment are a prerequisite to informed consent. Despite these imperatives, clinicians do not routinely receive training in key communication skills that could enable them to accomplish these tasks. A body of literature is available, however, that identifies communication strategies that can (1) facilitate the establishment of a close rapport with the patient, (2) identify the patient's information preferences, (3) ensure comprehension of key knowledge and information, (4) address the patient's emotions in a supportive fashion, (5) elicit the patient's key concerns, and (6) involve the patient in the treatment plan. In this article, we use dialogues between a physician and a hypothetical patient with advanced ovarian cancer to illustrate how communication techniques can be applied to accomplish these goals. We identify important benefits of the use of these techniques for both the physician and patient, and pose several questions regarding the training of physicians in this area.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Phantom breast pain as a source of functional loss.Although physicians are aware of phantom limb pain, which can occur in up to 85% of patients who undergo amputation, and its potential effect on functional status, the presence of phantom pain after amputation of other body parts such as the breast and its effect on function may be less appreciated. We report the case of a 63-yr-old woman with multiple sclerosis who underwent a modified radical mastectomy for left intraductal breast carcinoma. After her mastectomy, she required a brief course of inpatient rehabilitation and was discharged from rehabilitation independent, with feeding, dressing, hygiene, and transfers. Two months after her mastectomy, she had difficulty with these tasks because of phantom breast pain. Accurate diagnosis of her pain and successful treatment resulted in a return to premorbid functional status.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
3/6. A family history of pancreatic cancer.BACKGROUND: A 65-year-old white male with a family history of pancreatic cancer and a personal history of two episodes of acute pancreatitis was referred to our department in January 2005 by his primary-care physician for an assessment of his pancreatic cancer risk. INVESTIGATIONS: Physical exam, laboratory investigations, CT scan, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography. diagnosis: Familial pancreatic cancer. MANAGEMENT: Subtotal pancreatectomy, referral to genetic counselor, and continued surveillance.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
4/6. cervical intraepithelial neoplasia during pregnancy.The evaluation and management of the pregnant patient with abnormal results of cytology is a special challenge to the physician. We present a study of 109 patients with abnormal cervical cytologic findings during pregnancy, with detailed guidelines for the evaluation and management of these patients. The use of cytology, colposcopy, and directed biopsies is encouraged.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/6. Bilateral breast carcinoma after radiation therapy for Hodgkin's disease.The success of modern cancer therapy is resulting in an increasing number of long-term cures. The price of success, however, is the incidence of treatment-related morbidity and mortality. The physician should be aware of the potential sequelae of cancer therapy. A case of bilateral breast cancer occurring 13 years after radiation therapy for Hodgkin's disease prompted me to examine the incidence of this problem and to make recommendations for surveillance of patients.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/6. Bilateral testicular cancer.Although the case we described is not common, the incidence of testicular cancer, as well as bilateral testicular cancer, is rising. The primary care physician can help reduce morbidity in these patients by encouraging monthly self-examinations of the testicles and by paying attention to high-risk subgroups, such as those with a family history of testicular cancer, a personal history of cryptorchidism, infertility, or a contralateral testicular volume less than 12 mL. The primary care physician should, in at least these cases, discuss the option of a testicular biopsy to rule out CIS in the contralateral testicle. Treatment and follow-up options can then be explored to reduce further sequelae from this disease.- - - - - - - - - - ranking = 0.66666666666667keywords = physician (Clic here for more details about this article) |