Oncologists combine science with humanity
For Dr Bhaumik Shah, oncology is not the “dark art” that many believe, but a specialty in which he can make a real difference through treating people with curable cancer and easing the final days of people with terminal disease.
“Junior doctors or medical students wrongly feel that oncology is depressing — that patients don’t have any hope and that they all die”, says Dr Shah, a medical oncologist who splits his time between Ballarat Base Hospital and Peter MacCallum Cancer Centre in Melbourne.
“With early detection and improved treatment, we are able to cure more and more people”, he says. “It’s also a success when we help a person at the end of their life to pass away peacefully. How a person dies lives in the memory of those surviving.”
Dr Shah, who started working as an oncology consultant early this year, was drawn to the specialty because of the close connection with patients.
“When we talk at length, and I tell them the facts and explore their fears, that can be very relieving, not only for the patient but for the whole family”, he says.
Dr Shah says another attractive aspect of medical oncology is rapid progress in the field. He is using a dozen medications that didn’t exist when he started medical school in 1997. “It feels like we are working in a field that is on the cutting edge with new things coming all the time, because there is a lot of research going on”, he says.
Dr Pretoria Bilinski is a medical oncologist and palliative care physician at Greenslopes Private Hospital in Brisbane.
She says oncology offers her the opportunity and privilege to help people with incurable disease to have more time and better control of their symptoms.
“A lot of colleagues think it is depressing”, she says. “But I get a lot of satisfaction from helping people at one of the worst times of their lives.”
Dr Shah believes the biggest challenge for oncologists is to maintain their emotional and physical health.
“When you provide empathy and care to people all the time, there is a risk that you can get burnt out, and that emotional exhaustion can affect your personal life”, he says. “It’s very important that we look after ourselves, by sharing what we feel during our work life with our colleagues and our family.”
Dr Bilinski says her work can be distressing, especially if she is treating a patient who is in a similar life situation to her, such as a young mother with children.
While she doesn’t have any formal opportunities to debrief, she finds it helps to talk to colleagues at conferences and networking functions.
Dr Shah says another challenge of oncology is its multidisciplinary nature. “Patients see so many different people that sometimes it is unclear who is leading the team”, he says.
“It’s important we communicate with all the people providing care, and coordinate the patient’s care so there is no duplication and there are no gaps through which patients can fall.”
Dr Bilinksi says oncology trainees who have young children face additional barriers.
She says the training program needs to be more flexible to encourage more women to be part of it. “While the program is improving, most women who want to job share have to find the person to share with, and it would help if the training program connected people.”
The inside story
Like most specialties, there is strong competition for an advanced training place in oncology, so how do you stand out to selectors?
Brisbane oncologist Dr Pretoria Bilinski says selection committees may favour people who worked with them as basic trainees because they know them better. “Try to have rotations in the institutions in which you want to do your advanced training”, she says.
Victorian oncologist Dr Bhaumik Shah recommends that candidates highlight their communication skills, which are vital in oncology.
“People usually learn these skills by seeing other doctors at work or attending communication workshops. If they can prove to the selection panel they have something extra in terms of their communication skills, it can help to set them apart.”
Professor Bogda Koczwara selects and trains many advanced trainees in her role as Director of Medical Oncology at Flinders Medical Centre, Adelaide.
Professor Koczwara says she looks for a blend of skills in candidates. “I need trainees to be meticulous and rigorous in their scientific thinking because we deal with drugs that can kill you and we deal with precise treatment — but they also need to be respectful, compassionate and attentive to people”, she says.
“I’ve seen trainees who are incredibly passionate and caring, but they don’t pay attention to detail when calculating drug doses. I’ve also seen trainees who know the latest molecular pathways, but when their patient falls sick at 4.55 pm, they say, ‘I’m going home’ and walk out”, Dr Koczwara says.
“You have to have a balance between the two, because when you put the science and the humanity together, that’s when the real magic happens.”
The training program
Basic physician trainees can choose medical oncology as a career path during the last year of basic training. Trainees who elect to do medical oncology spend two years in core training in medical oncology and one year in elective training in a discipline that directly relates to medical oncology. (Source: Medical Oncology Group of Australia. For more information, go to http://www.moga.org.au)