<![CDATA[subatomicdoc - Blog]]>Sat, 28 Mar 2026 06:40:03 -0400Weebly<![CDATA[Radiation Oncology: Stories that need to be shared]]>Thu, 22 Jul 2021 10:28:26 GMThttp://www.subatomicdoc.com/blog1/radiation-oncology-stories-that-need-to-be-sharedRecent articles about radiation safety from The New York Times keep reminding me of something I learned my first year of residency: radiation oncology is one of the most opaque specialties in medicine. And it’s hurting our ability to help our patients.
During one of my first rotations at Memorial Sloan-Kettering Cancer Center, I spent time following a renowned medical oncologist around in clinic. One of his patients needed radiation therapy. “Just buzz him,” he said. Further discussion made it clear: he had no sense of how the radiation was done, and he had not seen a linear accelerator in two decades in oncology.
In the decade since that conversation, I’ve continually been impressed by the degree of fear and misinformation surrounding radiation oncology. As a volunteer with ASTRO, I believe we need to focus more effort on effectively communicating what we do. Unless we dedicate ourselves to telling our stories, The New York Times and others will do it for us.
To some extent, radiation oncology is a victim of its own successes. Technical and scientific advances have been exciting and beneficial to our patients. Often, the overt emphasis in training is on technology, expertise and specialization.  Interpersonal skills are valued but not often cultivated or taught. Unless we want to be technicians, we must use the humanistic aspects of our training more rigorously.
Despite the rigor we instill into our work, ultimately medicine is a social science.  Doctor means teacher in Latin. Whether it’s a breast cancer patient afraid that radiation will make her lose her hair or the congressional aide who thinks you are a radiologist, you can share your knowledge and stories to help educate them.
Better communication can also help inform the nurses, therapists, dosimetrists, physicists, administrative assistants and other health professionals we depend upon so that we provide better, safer treatment. Communicating is a learned skill, so we need to work at it. But that’s why it’s called medical practice, after all.
If we hone our skills in storytelling and put a human face on the field, radiation oncology will be better able to provide a clear, cogent narrative on many important issues:Social media competency may be an opportunity for us to share that we care.   By sharing our stories, we can learn together more effective ways to educate and to demonstrate how valuable our work is on all levels: personal, professional and societal.
But sharing must flow both ways. Listening to the stories of our patients, colleagues, and critics can help us heal more effectively and provide new opportunities to improve cancer care.  Whether it’s in an exam room or a chat room, at an academic conference or a tweetup, we are in an ideal position to improve the health and quality of digital life.  Social media are no panacea, but if we don’t learn how to communicate effectively both in person and online, our ability to meaningfully care and advocate for our patients will be diminished.  When we do learn how to share, the story is more likely to have a happy ending.
Matthew Katz, M.D. is a member of the Advisory Board for the Mayo Clinic Center for Social Media. This article is adapted from his original post at ASTROnews.

Originally posted on Mayo Clinic Center for Social Media, May 11, 2011
]]><![CDATA[Viewpoint: 6 Trends Toward Higher Cost, Worse Health, Less Access]]>Thu, 22 Jul 2021 10:07:15 GMThttp://www.subatomicdoc.com/blog1/viewpoint-6-trends-toward-higher-cost-worse-health-less-accessOriginally posted on the Mayo Clinic Center for Social Media, July 1, 2015

The Supreme Court just confirmed that Affordable Care Act (ACA) subsidies are constitutional.  But the jury is out on whether the ACA may help or hurt our health. Now that ACA can move ahead with more momentum, what other trends might drive us toward worse outcomes? Here are six big ones:

1) Hospital Consolidation
The ACA created incentives for Accountable Care Organizations to “give coordinated high quality care” with promised shared revenues for cost savings. The size of ACOs needed to achieve any savings favors hospital industry consolidation.
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Dollars now spent on legal fees and costs of integrating different hospital systems mean less available for patient care, attracting quality physicians, or investing in new services. Hopefully all these resources will be a good investment for future cost savings, but don’t count on it.

Robert Wood Johnson’s Synthesis Project (2006) reported likely increases of 5% or more in health care costs with consolidation. The effect is worse in smaller geographic areas where oligopolies are created. In California, concerns were raised about higher costs occurring when hospitals and providers bargained together with payors.  In Massachusetts earlier this year, the Suffolk Superior Court stopped a merger for Partners Healthcare due to concerns of increased costs for the Commonwealth without proof of improved access or quality.

2) Meaningful Use
The HITECH Act passed in 2009 as part of a stimulus package designed to expand use of electronics health records (EHR). Up to $27 billion in incentives were authorized to promote EHR adoption with the goal of ‘meaningful use’ – improving the quality of care.

The cost of implementing EHRs is hundreds of billions more than the government incentives. Software purchase and maintenance, training staff, hiring medical scribes are more money diverted from helping patients. Again, There’s no good evidence to date that EHRs will improve outcomes .
Technology is no panacea but continues to drive healthcare costs up. And as stimulus funding dries up, EHR consolidation is next – forcing many professionals to relearn another system and hospitals to pay more for surviving systems.

Consolidating electronic health information makes it easier to raise costs through medical fraud and identity theft. A recent multinational report confirms healthcare data breaches are the most expensive, costing an average of $398 per exposed person in the U.S.  Anthem had a breach of 80 million customers earlier this year; do the math. EHRs make another potentially rewarding target. What will happen as Epic Systems, the largest EHR provider, becomes cloud-based?

EHRs are also designed for charge capture more than clinical use. So a lot of time is spent by providers learning a clunky system and less time focused on patients. This has spawned a new profession: medical scribes who document so the doctor or nurse can focus on patients. There may be some cost savings, but medical scribes are an unintended consequence that only increases the number of people needed to do the same job.

3) Physician Employment
Speaking of jobs: increasing numbers of doctors are employed by hospitals rather independent practice. There’s no strong evidence this trend improves outcomes, but recent data suggest physician employment increases the cost of healthcare.

Some doctors don’t want the increasingly complex challenges of private practice. With median debt levels of $180,000 for 2014 medical student graduates, some may not have a choice as non-profit hospital employment can provide benefits for debt relief.

Early data suggest buying practices is costly to hospitals – who pays those prices? Employment contracts may incentivize productivity (more patients, tests or procedures). With more time spend documenting, the only way for a doctor to maintain productivity is to spend less time talking to patients, and even less time listening to them.

4) Patient Satisfaction for Reimbursement
Be careful what you wish for – you might be treated like a V.I.P.
The ACA links hospital reimbursement to patient satisfaction with HCAHPS. The incentivized desire to please patients may result in excessive testing, medication or hospitalization.  Giving bad news about a poor prognosis could help curb excessive treatment but can make doctors appear less compassionate – so let someone else give it. Give the customer what s/he wants, you may get repeat customers but costs will go up.

An additional problem: patient satisfaction may not be linked to good outcomes.

One large study suggests satisfaction is linked to higher mortality and hospitalization. Another shows satisfaction is linked to less readmission rates but higher mortality rates. Better preventive health services use is actually linked to worse patient satisfaction.  While it’s important to be responsive to people’s needs, patient satisfaction is not a good measure of good care.

Using HCAHPS may also unfairly penalize hospitals with underserved populations. A recent study showed white, educated, English-speaking hospitals were more likely to have high HCAHPS scores. Ultimately this may limit access or growth of new programs where they are needed most.

5) Health Information Online
When people don’t have access to care, they’re more likely to go online for health information. There are some benefits, but there are also risks. It’s a great place to be exposed to a lot of direct-to-consumer marketing and anecdote. Social media are great resource for illicit online medications, and often what patients learn from DTCA and discuss with doctors may be problematic rather than helpful. Celebrities sharing opinions on health may also make it more difficult.

Younger, more educated people use the internet for health information, but they’re also more likely to be misled by anecdotes while feeling more empowered. Unfortunately There’s a tendency for sicker people to share experiences more online, risking misperception of the severity of illness or treatment side effects. This selection bias sharing bad stories may then excessively undermine public trust in health professionals and hospitals.

When used through a patient portal, online access may be linked to more office visits, telephone calls, ER visits and hospitalizations compared to patients who didn’t have online access. Effectively that means tilting clinical care toward patients who go online, meaning less time in clinic for patients who use the internet less.

6) Rising Deductibles and Underinsurance
The ACA provides access to insurance, but increasingly people have poorer coverage. A recent report suggests 31 million people are underinsured, increased to 23% of adults 19-64 in 2014 compared to 12% in 2013. The main cause is linked to higher deductibles. As a result, 44% of underinsured people have had at least one cost-related access problem.

There may be other unfavorable or favorable trends you have thought about. Many of the issues are complex and interrelated. Hopefully I’m wrong. But ignorance is not bliss. We need to question where we’re headed now that ACA and HITECH implementation move forward.

What do you see on the horizon for health care?

​]]><![CDATA[Seeing Healing Relationships Helps Us Value Them]]>Thu, 22 Jul 2021 10:02:27 GMThttp://www.subatomicdoc.com/blog1/seeing-healing-relationships-helps-us-value-themOriginally posted on the Mayo Clinic Center for Social Media, ​February 2, 2015

​Recognizing the needs of patients as well as doctors is essential to healthcare. We may have ideas about what those needs are, but how do we include them in decisions about healthcare reform?
Both patients and healers (since this doesn’t apply only to doctors) have to combine strengths and recognize weaknesses for a trusting relationship to emerge. Pure autonomy doesn’t exist for either participant; it’s the caring connection itself that defines our ability to cope with adversity and begin the healing process.
Trust in the relationship and an ethics of caring are cornerstones of relational bioethics advocated by philosopher of science Alfred Tauber. Improving health requires trust on the part of patient and doctor. The relationship is part of them, and they are partly defined by that relationship as well.
This dual identity fits with Arthur Koestler in his book The Ghost in the Machine “ ‘wholes’ and ‘parts’ in [an] absolute sense just do not exist anywhere, either in the domain of living organisms or of social organisations.”
Koestler used the term holon to capture that duality of being a part and a whole at the same time. I suggest that we view the patient-healer relationship as a “healing holon”:

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The therapeutic relationship is the core atom of healthcare; it’s what binds us together. If we want a better healthcare system, we need to start by strengthening that core, not eroding it. Strong healing relationships require that both patients and healers have their needs met.
One way to evaluate the value of institutional policies, technologies or legislation is to ask a simple question: Does this change improve or weaken patients, healers or their relationships?
If a proposed change does not have a net benefit on elements of the healing holon and promote trust, perhaps it’s not worth pursuing. This idea may give us a better way to evaluate new reforms.
What happens for someone with health issues? Multiple healing relationships have different value to a patient. For a woman with rheumatoid arthritis and some fractures as her main health issues, this is what it might look like:
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Doctors also experience multiple interactions. Here is what a busy day in clinic might look like:
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I can’t quantify the value of each holon, but these examples show how some relationships will be more important or trusting than others.  The more overlap and trust, the better.
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Seeing is believing, but you have to believe in something first to see a solution. What do you see? What do you believe?
]]><![CDATA[E-Patients Deserve E-Doctors: Addressing the Needs of Both to Make Healthcare Better for Everyone.]]>Thu, 22 Jul 2021 09:56:19 GMThttp://www.subatomicdoc.com/blog1/e-patients-deserve-e-doctors-addressing-the-needs-of-both-to-make-healthcare-better-for-everyoneOriginally posted on the Mayo Clinic Center for Social Media, ​December 29, 2014

Everyone deserves a chance to be healthy. Physicians, of course, focus on helping patients. Unfortunately, I often see patients’ frustrations with the health care system itself directed toward doctors.
Meanwhile, doctors are under increasing pressures on multiple fronts. Yes, we’re imperfect, but making physicians the primary focus of patient anger will not solve problems we all face as humans who will, at some point, need health care. (Note: I’m using doctors as an example for this piece, but my observations apply to all health care professionals.)
Patients need doctors. Doctors need patients. Let’s find a way to value both.
Patients deserve to be empowered
Health is more than not being ill. The World Health Organization definition puts the full range of patients’ needs first: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
How can patients achieve the health they deserve? Only if they’re empowered. The “e” in e-patient can mean many things, but if health is a basic human right, then empowerment is the only “e” ensuring that right.
Being empowered means being able to meet certain fundamental needs, ones that need to be in place before we can make accurate, informed decisions about health. Here’s what we need for empowerment:
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Image: Matthew Katz
Autonomy is not absolute
Empowerment isn’t the same as autonomy. True autonomy is the ability to make an independent, free choice. Sometimes we don’t have the luxury of time; pain may color our perspective. Loved ones often can have strong influences upon our decisions. Humans are relational by nature, not truly independent.
Sometimes we disagree with health care professionals. Even when doctors or nurses want to help, their experience or ethical concerns may prevent them from giving us what we want or need. Patients are inherently vulnerable.
In addition, while more people may currently be involved with shared decision-making or perhaps even lead the process, not all patients want complete autonomy. Patient decision-making preferences may vary based upon many factors. It’s not reasonable to insist that patients lead decision-making if they want to receive guidance or direction from their physicians.
Patients deserve access, dignity, and a chance to be involved in decision-making, but that doesn’t automatically lead to satisfaction. In our desire for control, some of our choices may actually hurt us. Rather than being angry at doctors and taking our frustrations out on them, I suggest we recognize and explore common ground that may help patients and doctors alike.
Doctors are patients too
When we’re sick, we understand that others who suffer and need help will rightfully compete for doctors’ attention. What we often fail to remember is that those helping us may also struggle with health issues.
While data suggest doctors are becoming better than the general population about their health when it comes to smoking and obesity, physicians have higher rates of burnout and suicide. Multiple surveys show many medical students and doctors may have suicidal thoughts, with one study estimating that up to 24% of doctors have thought about taking their own life at some point in time.
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Source:  beyondblue.org
Doctors haven’t made it easier on themselves. Excessively high expectations of a different era and a tendency to internalize stresses rather than seek help may lead to burnout, hopelessness, and self-harm. Access to medication also makes substance abuse a particular problem in some specialties.
Multiple factors contribute to physician burnout, depression, and impairment. We can’t solve or eliminate them all, but e-patients should want doctors to be healthy and well. Healthy doctors are more accessible, better listeners, and more able to dedicate time to patients. As a small subset of patients, doctors deserve mental and physical health to ensure they can be there for us when we need them.
So what do doctors need for empowerment?
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Doctors also have a hierarchy of needs
Healers need to be healthy first—just like patients. Then, they need the right personal characteristics, training and support to be better able to do their job—helping patients.
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Image: Matthew Katz
With health and virtuous characteristics as the foundation of success, doctors can earn the right to the trust of patients and their caregivers as well as society at large. This model affirms the patient-doctor relationship and aligns patients and doctors.
Making it better for everyone
We are all dissatisfied with an unhealthy health care system in a rapidly changing world. Empowering patients and doctors ensures they can work together. New technologies and tests are not solutions, they’re just tools. If patients and doctors don’t stand up for themselves, other stakeholders  (e.g. hospitals, insurers, industry)may unwittingly make things worse.
Thoughtful, vocal patients, caregivers and doctors should stand together. Even when we disagree, we can respect our differences while working toward solutions, both in clinic and for the health care system.
We both have a lot to bring to the table. Empowered patients are better able to collaborate. Empowered doctors are more able to adapt to each patients needs and communicate well to build trust. We need each other. And if we support each other, the entire health care system will be the better for it.
]]><![CDATA[Twitter Use at Three Annual Professional Meetings (2012-2014)]]>Thu, 22 Jul 2021 09:49:05 GMThttp://www.subatomicdoc.com/blog1/twitter-use-at-three-annual-professional-meetings-2012-2014Originally posted on the Mayo Clinic Center for Social Media, ​November 24, 2014

Last year, I wrote about differences in how professional societies use social media during annual meetings. This year, the American Urological Association (AUA), American Society of Clinical Oncology (ASCO) and American Society for Radiation Oncology (ASTRO) have had their meetings, so it’s time to take another look. Looks like the growth trend continues for sharing research and specialty-specific information in cancer care via social media.
Using Symplur’s hashtag analytics, I reviewed Twitter data for ASCO and ASTRO annual meetings from 2012 through 2014. I chose to include one week before and two weeks after the meeting since discussion typically extends beyond face-to-face conferences.
Symplur had data for #AUA13 and #AUA14. #URO12 wasn’t in Symplur so I reviewed it manually on Twitter.

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Fig. 1. Tweets  for ASCO, AUA, and ASTRO from week before to two weeks after annual meeting. (2012-2014)
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ASCO, which has been ahead of the pack for professional societies using social media, has shown continued strong growth in using Twitter. The increase in tweets mirror the increasing number of participants:
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Fig. 2. Participants tweeting from week before to two weeks after annual meeting. ASCO, AUA and ASTRO
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On an absolute scale, ASCO is the leader, but note that it has been strategically using social media longer than either AUA or ASTRO. And how are those organizations doing based upon growth rates? Pretty well.
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Table 1.   Social media metrics, 2012-2014.

AUA used #URO12 because a competing meeting was already using #AUA12, but #URO12 apparently wasn't intuitive enough. Meanwhile, ASTRO appears to be lagging approximately one year behind AUA in most measures. Both organizations’ meetings had an increasing number of tweets per participant. ASCO’s Twitter use has been flat.

To what extent do the organizations themselves play a role in advocating Twitter activity?

ASCO, ASTRO and AUA have all grown their online presence with Twitter. But ASTRO hasn't been as proactively tweeting at its own meeting as either ASCO or AUA.

In 2014, ASTRO had only 35 tweets using the meeting’s hashtag vs. 754 and 381 for ASCO and AUA, respectively. So far that doesn't appear to be hurting ASTRO’s growth in using its annual meeting hashtag. But is organizational engagement needed to sustain that growth, or are people going to increasingly use Twitter on their own?
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ASCO is a very large organization with over 34,000 members, so I wouldn't expect either AUA or ASTRO to reach quite the same level of participation. But both urology and radiation oncology appear to be on the same path – sharing more cancer information online.
So, is sharing at academic meetings trending good, bad or meh? Should organizations proactively lead tweeting during meetings? Should organizations let this grassroots process be initiated by meeting participants? I’d love to know what you think.
]]><![CDATA[Start the Patient-Doctor Relationship with Questions about Gathering Health Information]]>Thu, 22 Jul 2021 09:44:23 GMThttp://www.subatomicdoc.com/blog1/start-the-patient-doctor-relationship-with-questions-about-gathering-health-informationOriginally posted on the Mayo Clinic Center for Social Media, July 8, 2014

About one third of U.S. adults with online access will look up health information about a specific condition, but only about half will discuss what they've found with a doctor [Pew Internet]. Recent research suggests patients want to share what they learn online but often get a negative reaction from doctors.
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I think we can do better. Starting as collaborators could make a big difference in how medical care is delivered as well as received.
What if, during the very first doctor-patient visit, we talked about where patients gather health information and discussed how to find reliable resources? What if we asked our patients to tell us how they best learn and retain medical information? What if we told our own doctors how we learn?

During an initial visit, a symptoms-based review of systems is a standard part of taking a medical history. I'm suggesting we make time to review patients’ health information status as well.
A health information history would allow doctors to:
  • assess how patients learn and retain information;
  • correct misinformation and ineffective research habits
  • provide accurate, reliable resources
  • establish a positive, collaborative approach to sharing new information.
Take a look at this presentation for more about the questions I believe doctors should probably be asking, as well as what we should be prepared to provide for our patients.
What do you think?

https://www.slideshare.net/subatomicdoc/health-information-review-of-systems 
]]><![CDATA[Annual Meeting Twitter Activity in 2013: Four Professional Societies]]>Thu, 22 Jul 2021 09:40:28 GMThttp://www.subatomicdoc.com/blog1/annual-meeting-twitter-activity-in-2013-four-professional-societiesOriginally posted on the Mayo Clinic Center for Social Media, November 18, 2013

It’s always busy when you attend a professional society annual meeting – attending academic sessions on new research, health policy, educational sessions, networking, catching up with friends, recruiting or job searches, and more.  Increasingly, these interactions are being captured online.
Twitter is great at capturing some of these real-time interactions – so who is using it as a way to share his or her annual meeting experience?
I decided to pull free data from Symplur on four recent professional society meetings with submitted hashtags:  American College of Surgeons (#ACSCC13); American Society of Clinical Oncology (#ASCO13); American Society for Radiation Oncology (#ASTRO13); and the American Urological Association (#AUA13).  I did not filter through carefully to separate out possible other uses of these hashtags, so the results should be taken with a grain of salt.  Because of chatter that often occurs before and after the meeting, I included one week before and two weeks after the meeting itself.  Impressions are measured by the number of tweets multiplied by the number of followers of the person tweeting.
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The results are very interesting:
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Online impressions, 1 week before until two weeks after the meeting

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#ASCO13 had dramatically more absolute activity than the other society meetings – over 67 million impressions.  Also important is that the society itself took an active role with 490 tweets during that time period.  As a result, it had 9.8 million impressions in less than four weeks – a lot of attention for ASCO!
Now ASCO is a very big meeting compared to ASTRO – I’ve never attended the other two meetings.  But it has had a significant increase in Twitter use even from past research by Bob Miller.  Part of it is the higher number of people using Twitter.
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Tweets and participants during the meeting

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For ASCO, these all represent significant increases from earlier research looking at 2010-2011 Twitter use.  But from 2012 there was 68%rise in the number of participants from 2239 to 3751.  ASCO staff also got much more active –tweets about the meeting jumped to 490 from just 147 in 2012.
When you look at individual activity, the ACoS and AUA tweeters were more active, averaging seven and eight tweets each, respectively.  ASTRO was similar to ASCO at four versus five per tweeter.
Does that mean ASCO will influence cancer care more than the other meetings?  Not necessarily.  But some research suggesting tweet activity are linked to higher research article citations and downloaded preprints of scientific research.  Twitter may be relevant to how effective professional societies are at sharing research and the organizational mission.
The combined effect of more participants, more activity and more influence gave ASCO a major edge.  But with wider adoption among annual meeting attendees, don’t be surprised if the other three organizations catch up.
More research is needed, and my datamining on Symplur was very broad and simplistic.  But it’s a good way to start a conversation about the value of social media for physicians.  What do you think about Twitter use at academic meetings?
]]><![CDATA[Should Chats on Twitter Have Disclosures?]]>Thu, 22 Jul 2021 09:35:00 GMThttp://www.subatomicdoc.com/blog1/should-chats-on-twitter-have-disclosuresOriginally posted on the Mayo Clinic Center for Social Media, September 20, 2013

I've been participating in multiple live conversations on Twitter that have been very rewarding.  These tweetups, or tweetchats, offer an opportunity to share information, network, and enhance advocacy for improving healthcare.  But do we need to give people some caveats about sharing?
In the setting of discussions like #hcsm or #meded, where it's general conversation but not specific diseases, not necessarily.  However, when it comes to attracting people with a certain health condition it may be different.  Tweetchats can be very engaging, and keeping up with the conversation means it's easy for someone to accidentally share more about himself or herself than intended while caught up in the flow of conversation.  Sharing health information isn't necessarily a problem but an otherwise cautious, private person may forget that Twitter is a public forum.
The other main issue is that community is a double-edged sword.  It's fantastic at reducing isolation and allows people to find others with similar concerns and passions.  However, it also means that it may amplify some negative aspects of healthcare experience or disease experience that otherwise wouldn't be as bothersome.  Doctors may find themselves more dissatisfied from gravitating toward other frustrated clinicians online than they would if they only interacted with immediate colleagues.  Cancer patients may go through more grieving and stress because they've magnified their exposure to people with a potentially life-threatening condition exponentially.
I've been involved in helping develop a new tweetchat #gyncsm for discussions around gynecologic cancer.  For that chat I developed a disclaimer to share with each tweetup which is now posted by one of the founding members.
What do you think? Is this a good idea or not?
]]><![CDATA[Health Tag Ontology Project: Adding Meaning to Social Media?]]>Thu, 22 Jul 2021 09:33:04 GMThttp://www.subatomicdoc.com/blog1/health-tag-ontology-project-adding-meaning-to-social-media]]><![CDATA[No More Magic Bullets]]>Thu, 22 Jul 2021 09:31:00 GMThttp://www.subatomicdoc.com/blog1/no-more-magic-bulletsOriginally posted on the Mayo Clinic Center for Social Media, January 9, 2013

In the wake of the Sandy Hook massacre, it’s time for reflection on how to make 2013 a better year.  In the house of oncology, we may want to stop using our words as weapons.
As doctors, we are responsible for not only understanding disease processes but explaining them to our patients.  There was a time when cancer was scary enough conversation wasn’t possible.  And when Nixon started the ‘war on cancer’ with passage of the National Cancer Act in 1971, it has the potential to empower us when before it was too frightening to even mention. We have made tremendous progress in understanding cancer at a molecular level.  But the war metaphor may limit what progress we can make.
Disease as adversary
Cancer is a ‘killer’, invading the body and can be malignant.  Rapidly growing tumors are ‘explosive’, slow growing ones may be ‘smoldering’ but just waiting to advance.
Patient as battleground
From the outset, patients are sent to war.  Newly diagnosed patients are recruited into the militaristic model to fight.  The alternative is to be loser in a metaphorical battle, or to be a victim if one choose not to fight.
Sacrifice is required in wartime. Patients are advised to accept surgery, chemotherapy and radiation therapy. times like this, it’s harder to ask questions without being seen in a negative light. Unfortunately, the rush to action sometimes means misunderstanding treatment options and poor informed decision-making.  It can lead to decisional regret, emotional or physical health consequences.
It’s a win-lose proposition in war, but even the ‘winners’ often are left with ‘battle scars’ and emotional distress.  We don’t use the word cure in oncology, which leaves the perpetual need for readiness and the need the return to the field of battle. When recurrences happen, often we discuss ‘salvage’ therapy.  Who wants to be seen as a failure with maybe a second chance?
Clinician as aggressor
Usually it is doctors who formulate the ‘plan of attack’.  Our decisions may be rational, but with the language we use sometime it seems more like we’re field generals rather than healers.  Even with the successes of molecular medicine: “we are moving from the indiscriminate use of large-scale carpet-bombing to the pinpoint accuracy of guided missile attacks.”  Whether those missiles are molecular ‘targeted’ pharmaceuticals or ionizing radiation, we are authorizing treatment which may have lasting collateral damage.
At any price?
The financial cost of cancer care continues to rise, and the war metaphor may make it more acceptable to pursue very expensive treatments with little proven benefit.  This concern may apply to experimental testing, drugs, and proton therapy.  Even after cure, patients may face indebtedness which hurts their quality of life and may compromise their families’ future well being.
A new narrative
We have made so much progress in understanding cancer as a wide constellation of proliferative diseases in the past 40 years. But I pledged to be a healer, not a fighter. It’s time to put our weapons down and find a new way to explain and treat cancer.
Additional Reading:
Don Dizon, The Language of Cancer, ASCO Post, 2012
Gilles Frydman, Terrorized by the ‘War On Cancer’, E-patients.net 2009
Mike Marqusee, I Don’t Need A War To Fight My Cancer, The Guardian, 2009
Ellen Ormond, Avoid The War Metaphor In Cancer Treatment, New York Times, 2009
Richard Penson et al., Cancer as Metaphor, The Oncologist, 2004
Susan Sontag, Illness as Metaphor, 1978
Melinda Wenner, The war against war metaphors, The Scientist, 2007

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