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Mark Lewis, MD, FASCO

@marklewismd

Jun 24

It's been exactly 20 years since my first day of internship

As I reflect on my disproportionate aging since then (gray hairs >>> wisdom), here are my 10 unsolicited recommendations for any colleague embarking on residency

THE "ATTENDING ADVICE YOU DIDN'T ASK FOR" THREAD ...

1. ADMIT WHAT YOU DON'T KNOW

You've never had more info at your fingertips (whereas I showed up day 1 with so many reference books stuffed into my white coat pockets that the seams split) but specifically NEVER fabricate patient data! Rather: "I'll look it up & get back to you"

2. ASK FOR HELP

My 1st overnight call, I was so proud of myself for reversing a prolonged PTT with protamine when I could have just held the heparin drip

When I told my upper level in the morning he was half-bemused, half-furious that I didn't seek oversight

You are NOT alone

Read 12 tweets

Mark Lewis, MD, FASCO

@marklewismd

Jul 2, 2024

Exactly a year since the ABIM first famously advertised 👇the liberation of Longitudinal Knowledge Assessment during travel, I got an email while overseas that they'd informed my hospital credentialing department that I am no longer in compliance with Maintenance Of Certification

4.75 MOC credits (out of the requisite, previously earned 100) simply vanished (much like any hope of work/life balance on this trip, I suppose)

https://x.com/marklewismd/status/1775149522013843570

Now, I'm no stranger to the elusiveness of perfection
(and frankly 95.25 out of 100 is a lot better than my usual score; I'll take being an A student any day!)

https://x.com/marklewismd/status/1775149522013843570

Read 11 tweets

Mark Lewis, MD, FASCO

@marklewismd

Mar 23, 2024

Yesterday my healthcare institution's media department fielded several requests from news organizations wanting to talk to an oncologist about Princess Catherine's cancer diagnosis & treatment

When speaking carefully to reporters I realized:

WORDS MATTER IN ONCOLOGY

/thread

A TUMOR BY ANY OTHER NAME

Many patients with cancer have to navigate a linguistic minefield with each new scan

Even in the era where the text of radiology reports may be immediately available to read, synonyms abound to the point of confusion: mass, lesion, neoplasm, tumor ...

THE ONCOLOGIST WITHOUT THE PATHOLOGIST IS BLIND

The reality is that scans are seldom enough to make a cancer diagnosis

We have a medical term -- pathognonomic, from the Greek pathos + gnomon ~ suffering + judge -- meaning an appearance that's totally distinctive of a disease

Read 16 tweets

Mark Lewis, MD, FASCO

@marklewismd

Mar 22, 2024

I'm being bombarded by questions (quite understandably) about why any patient would undergo chemotherapy if a surgery had successfully removed their cancer

I struggled to come to the same understanding when I was first being trained as an oncologist

A THREAD

Not all chemotherapy is given because we can discern a tumorous mass, whether palpably on physical exam or, less superficially, visually on scans of the inside of the body

Even after an operation where a surgeon may say/think "we got it all!" microscopic residue can remain

In time, cells "left behind", say at the edge of an operative field or beyond, will tend to grow, as cancer is unfortunately prone to doing (its very hallmark is unchecked proliferation)

Enter the difficult concept of adjuvant chemotherapy

Read 10 tweets

Mark Lewis, MD, FASCO

@marklewismd

Feb 20, 2024

My father died thirty years ago today

He was 49, I was 14

Most charitably it can be chalked up to my immaturity at the time of his death but it’s taken the full three decades since then for me to realize that I am not “getting over it”

I am never getting over it

The knottiest problem of grief arises when any recollection of the deceased becomes inextricably intertwined with re-opening the wound of their loss; the strands become too tangled for selective recall to unbraid painlessly

No wonder, then, that denial is the readiest reaction, the most reflexive of the Kubler-Ross stages, like a figurative hand withdrawn from a truth too hot to handle

When faced with a waking nightmare, it’s easier just to fantasize that it is all a bad dream

Read 21 tweets

Mark Lewis, MD, FASCO

@marklewismd

Nov 17, 2023

WHY I (ALMOST) NEVER BOLUS 5-FLUOROURACIL

I've been pondering this thread for a while but it's become more urgent in light of another looming chemo shortage <deep sigh>, this time with an imminent dearth of THE foundational drug of GI oncology: 5-fluorouracil, or 5-FU

An attending of mine from fellowship said "every patient with GI cancer deserves to receive FOLFOX" and, while that may have been a statement of its time (I trained 2009-2012, pre-KEYNOTE 177!) it still has the ring of truth today

So, while we should ALWAYS be thoughtful prescribers of chemotherapy (primum non nocere, anyone?), if we have a finite supply of 5-FU, and some other cytotoxic drugs are likely only active with a fluoropyrimidine backbone, we should be particularly parsimonious with its use

Read 17 tweets

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