These Are a Few of My Least Favorite Things

Keith Stewart, MBChB, MBA
Carlson and Nelson Endowed Director, Center for Individualized Medicine, and Vasek and Anna Maria Polak Professor of Cancer Research, Mayo Clinic in Scottsdale, Arizona

Although not validated by CLIA-certified genomics testing, I believe that I am certifiably of Scottish descent and, therein, probably have the genome of a marauding Viking crossed with some scrofulous ancient Highland crone. Thus, despite years of mellowing in gentle Canada and sun-accelerated aging in the Arizona desert, I remain congenitally disposed to the autonomic impulse to be irritated by almost anything.

This month, I’m using this Editor’s Corner to guide you through the assaults on logic that populate the daily life of a hematologist. Individually, they are trivialities, but cumulatively, they erode even the most steadfast of resolves. So, here are a few of my least favorite things (circa March 2015).

A recent addition to my naughty list are the apparently well-educated and well-fed league of vaccine-deniers and gluten-intolerance–enthusiasts. They must travel in circles where inventing medical conspiracy theories is worn as a badge of honor.

On a related note, I also point a middle finger at the morally dubious peddlers of the vitamins, natural supplements, and homeopathic products flooding the water treatment plants of California. Last month alone, I endured six phone calls on topics of medical misinformation, such as measles vaccination after transplant, the more chronic need for a stock answer on the role of turmeric in battling lymphoma, and why eating less sugar will not actually halt myeloma in its tracks.

Sadly, my Luddite viewpoint is quixotic; when our new cancer center proudly opens later this year, our integrative medicine program will occupy a large amount of that sunlight-flooded, ground-floor, easy-access, LEED-certified prime real estate. Our clinical trials staff will no doubt find the dark cubicles in the local concrete block warehouse much more to their taste.

Let’s delve further into that Luddite mentality… Can I be the only one whom memory has tricked into believing that, armed only with the hopelessly inefficient tools of a pen and paper, I could complete rounds in half the time and see twice the number of outpatients than I do with the electronic health record?

I won’t devote more words than necessary to the “miracle” of the EHR. I have reached symbiosis with that – in fact, I suspect an hour of training would reveal a whole universe of magical time-saving tricks, efficiencies, and a swiftly moving stream of appropriately coded invoices. For now, though, I have learned to master the essential few codes that get me through the clinic day. For anything more complex, I’ve perfected an imitation of a bewildered toddler that serves to convince the nearest nursing colleague to come to my rescue.

Electronic case report forms for clinical trials, on the other hand, have recently merited my distaste. Admit it – you too have reached for the nastygram when your friendly CRO demands you complete the very overdue case report form on a patient treated 26 months ago, using your eight-digit password that combines both numerical and alphabetical characters – and a symbol for good measure.

Actually, does anyone like the phrase contract research organization? I sincerely doubt it. Hearing those words elicits the same Pavlovian reaction as the words compliance, Sunshine Act, re-certification, training video, overdue manuscript, priority score, disclosures, insurance authorization, and invasive aspergillus.

Leaving the clinic and entering the hospital, the itch I cannot scratch is a long-standing grudge against the banning of children from their vitamin D depleted parent who is experiencing the joys of 7+3 in a flower-deficient environment. Can anyone show me real evidence as to the harmful effects of supposedly spore-laden flowers? Please let me know — I am genuinely willing to be convinced that the flower ban is correct.

Speaking of 7+3, I was using it as an intern in 1984. So, I add the lack of progress in leukemia research to this list of chronic irritants.

Continuing with the infectious disease theme, it is rumored that a member of our hospital kitchen staff has created neutropenic-safe fruit and, among other daily duties, is washing bananas free of deadly pathogens. There’s so much more ground to cover here, to start: the endless putting on and taking off of yellow gowns (secondary to all that contaminated fruit, flower, and child snot), the CMV/EBV testing of patients prior to autologous transplant, neutrophil transfusions, and re-vaccinations post-transplant.

Oops – does that mean I am on the verge of vaccine denial? I am probably on even dodgier ground when I tell you I am deeply suspicious of engraftment syndrome, autologous graft-versus- host disease (an oxymoron if ever there was one), and anyone who likes heparin-induced thrombocytopenia testing and inferior vena cava filters.

Finally, as I am in mid-air as I write this, people who bring lap dogs on planes are also a bit annoying. Pass the medical marijuana – I might need some.

The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

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