Rx’s for Doctors

Internists: Good News on Cancer described the recent reductions in cancer rates, especially because of colorectal screening. As you know, patients approaching age 50 have several options for colorectal screening.

Advice for internists who use paper charts: Have the receptionist identify each morning which of the day’s patients are nearing age 50. Have them place a PostIt note with a picture of a colon or pair of buttocks onto the front of the chart. That will give you a memorable, cheap, and confidential reminder to discuss options for colorectal screening with that patient, and you’ll start the discussion with a smile.


Oncologists: Now A Model Patient describes a cancer patient’s non-compliance with an outpatient oral chemotherapy order. It draws on this month’s article in the British Medical Journal by Dr. Saul Weingart et al. They found that two-thirds of the cancer centers in the U.S. write chemotherapy orders without writing the patient’s body surface area.

Advice for oncologists: If you hand-write oral chemo orders, make a special pre-printed form that has a space explicitly for the body surface area. That will prompt you to record it, giving the pharmacist a convenient way to verify that he or she is not dispensing an overdose.

Oncologists: Weingart’s survey found that “few” cancer centers get patients’ written informed consent for off-protocol oral chemotherapy drugs. This may well expose you to a risk of a lawsuit, and foregoes an opportunity to learn and honor the patient’s wishes.

Advice for oncologists: Have patients sign a consent form for off-protocol prescriptions.


Family Medicine physicians: Lucio Satar’s parents didn’t immunize him against the flu, and Lucio developed pneumonia, with complications, and died.

Advice: Please suggest to the families you see in the next few weeks that they get vaccinated.

Good News on Cancer!

Happy to hear that the number of cancer deaths in the U.S. has dropped for the second straight year. Even more importantly, the death rate from cancer has been falling about 1% a year since 1991.

By far the greatest decreases are in colorectal cancer, especially because more people are now screened for it. See our story on this. There are several fun screening methods to choose from--stool tests, colonoscopy (a scope of the entire intestine), and sigmoidoscopy (scope of the lower intestine). Only half the adults who should be screened have been screened. Screening rates are even lower for blacks.

Advice: Ask your middle-aged friends, especially your black friends, if they have been screened. Click the envelope icon just below here to tell them.

Read more in Denise Grady's NY Times article on Jan. 18.

Don't Let Haste In your Waist Make Waste: Colon cancer screening

Colonoscopy (examination by a doctor of your large intestine via a flexible scope) can detect and snip out cancerous and pre-cancerous polyps before they become harmful, and is recommended for 50-year olds. However, some doctors perform it more carefully and thorougly than others, and detect more polyps. Hasty doctors may catch only one-tenth as many as more careful ones! Doctors who take more time looking find more of them. On average, about a fifth of colonoscopy procedures detect one or more pre-cancerous polyps.

Lesson for Caregivers: If your doctor, or spouse's doctor, has a very low rate of detection of polyps, that may be a sign that their haste in doing the procedure has been causing them to miss many cancerous and pre-cancerous growths. Ask beforehand! If the doctor's detection rate is low, or unknown, find another doctor. Otherwise, you may find after your colonoscopy that you're left with the discomfort, the bill, AND. still, the polyps.

Share this with your friends who are about to have the big 5-0 birthday.

Read more in Gina Kolata's New York Times article: "Study Questions Colonoscopy's Effectiveness," Dec. 14, 2006, page A23.