Likes and Dislikes in Oncology

I took a selective in Oncology, which comprised both Medical and Radiation Oncology. Cancer is common and terrifying, so it was good to dig into the disease a bit further. Continuing on my series of rotation take-aways, here are my thoughts on my rotation:

1) Conversations
Oncology isn't that heavy on the medicine side of things - the science behind treatments is complex and incredibly interesting, but the actual approach to treatment is fairly formulaic. Where there is a degree of complex decision-making is in considering a patient's preferences, as well as providing education and counselling. As someone who takes the most enjoyment from medicine when actually talking to patients and helping them work through their condition, I loved this aspect of the field.

2) Time
Oncologists have time. Time to talk with their patients. Time to consider their medical and social situations. Time to arrange long-term supports. Cancer is scary, so we treat cancer patients pretty well from what I've seen. Plenty of room for improvement still exists, but it is kind of amazing to see patients being given plenty of attention and resources, in stark contrast to the way some other maladies are treated.

3) Death
For understandable reasons, death is a pretty big topic in Oncology. Many patients die, and die quickly. Moreover, patients are aware of their impending mortality. It's an element that scares a lot of people away from the field, because, well, death is scary. I find I don't mind discussing death though. It's inevitable, and physicians can do a lot to manage life on the way to death. I'm of the view that physicians are not meant to stop death at all costs, but rather to facilitate the best life possible - that second goal is very achievable in terminal patients, and I derive a lot of satisfaction from that.

4) Double-Edged Sword
For patients not yet clearly on the palliative track, the challenge with cancer treatments is that they all have trade-offs. Surgery, radiation, and chemo can all have side-effects, some quite significant. We're getting better treatments that minimize the more debilitating risks, but each approach still involves a good measure of chance. More than death, this is the element of working in Oncology that gives me pause. No matter how well an Oncologist practices, they will cause their patients harm as a course of their treatments. Much of this is temporary and can be managed. Some of it is permanent and without recourse. Good communication of risks and benefits before starting treatment can at least prepare patients for these possibilities, but it's still quite a burden to accept that someone was injured because of the treatment plan you, as a physician, put in place.

5) The Happiness Test

With few exceptions, Oncology physicians seemed to be very happy people. They work with the most life-breaking diseases in the world, so I suppose it takes an optimistic person to stay in that field. Everyone was super nice, not just to the patients but to me as well. You definitely notice a difference when there are smiles on most people's faces, even as they're hard at work.