Overdiagnosing thyroid cancer in Korea, docs “uncurious” about older patients, and two new books on end-of-life care
February 26, 2015
In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.
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Overdiagnosis is not just a huge issue in the United States. In a commentary piece written for the Lown Institute, San Won Shin, MD, describes how one doctor in his Korean province began ultrasonography screening for thyroid cancer in the late 1990s. Other doctors and clinics followed suit and the incidence of thyroid cancer skyrocketed.. According to Shin, thyroid is now the most common cancer in Korea, comprising 30 percent of all cancer diagnoses. Last year, Shin organized a coalition of Korean physicians to fight overdiagnosis of thyroid cancer, but they have met with considerable resistance from many physicians and hospitals.
In Medscape this week, Leigh Page chronicles some of the many challenges older patients face getting high-quality care. Relevant clinical trial data can be hard to come by for older patients, doctors buy into many cultural stereotypes about older people, and conversations about care for older patients are too often limited to end-of-life care, without searching for alternatives for making patients lives better prior to death. An unexplored theme of the piece is the importance of patient preferences: patients may have very different desires relating to screening tests, lifestyle modifications, and other interventions that were effective earlier in life, but may or may not be wanted as they grow frailer, and approach death. Many physicians may be insufficiently curious about their older patients, or unwilling to spend the necessary time to offer them the best care possible.
Amid the ongoing conversation about end-of-life care in the United States, Lown Institute Vice President Shannon Brownlee writes in the Washington Monthly the story of her own father’s death and reviews two important new books. The Conversation, by Angelo Volandes, MD, emphasizes our failures in helping patients and families understand what death, advancing disease and medical care immediately prior to death, look like. By providing an overly-rosy picture of what medicine can accomplish, patients and families may suffer needlessly. Alongside this book, Andy Lazris, MD’sCuring Medicare illuminates the regulatory structures that can make the challenging work of caring for elderly and dying patients even harder. Volandes will be speaking about his work at our conference, coming up in just over a week.