Is it exciting at least?

[Columbia22]

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Is radonc an exciting field? Is there a lot of medicine involved, or is it more like a glorified technical job (physicist, radiation therapy)? Is it cerebral or pretty routine? Do you feel like you are actually helping patients, or is it all just very depressing? How much autonomy do the radoncs have?

 

[Gfunk6]

RadOnc is a very exciting field (to me 🙂 ). There is a ton of research going on (clinical, physics, and radbio) and there are a lot of new toys to play with. The level of medicine involved is similar to what you would see in a standard outpatient clinic with a heavier emphasis on the organ system involved. For instance, CNS guys will focus heavily on the neuro exam.

I find it very cerebral b/c treatment plans are always evolving and you have to stay up-to-date with the literature. One of the most attractive things I found about the field is its highly evidence-based nature. Residents are often asked by attendings to cite specific publications when they recommend a given treatment plan.

There is no doubt that a good chunk of your patients are terminal or have a poor prognosis, but I enjoy this apsect. Giving patients hope or, at least, some palliation of their pain is very rewarding to me.

RadOnc docs from a highly interdisclipinary team with oncologists from other fields. There is a lot of inter-referrals that go on b/w members of your oncology team. Again, familiarity with literature is key as certain types of cancer (e.g. colon) have a limited or no role for XRT. You are the head of the RadOnc team however and, in that respect, have plenty of autonomy -- though there is a heck of lot of quality control (and rightly so) going on to verify treatment plans.

 

[radonc]

agreed.

a lot of physicist/dosimetrist who are clinically oriented can put fields together that could treat the majority of patients. however, the physician needs to know when to treat lymph node regions at risk (and why), when to exclude normal tissue and at what doses (given pt risk factors), and other such things. its what sets them apart from the technical staff. some physicians are more hands on than others...

 

[stephew]

its not typically exciting in the adrenaline sence but in the intellectual and patient care sence it is.

 

[deleted4401]

The worst day of this is better than the best day of medicine.

As far as large scale difference compared to medicine last year:
- you focus on TREATMENT; the major decision on every new patient you see is 'treat or not treat'
- although that may sound simple, all the decisions you make are based on your knowledge of clinical oncology and the current data, so you need a very broad and deep knowledge base
- the patients come in very focused; very seldom is it "My back hurts, I can't breath, and I'm having chest pain". They tell you they have breast cancer and they want it 'fixed'.
- with stereotactic radiosurgery, you really work with a large team - including the surgeons, dosimetrists, and physicists. I like getting to work with a lot of smart folks.
-In the same vein, there are lots of tumor boards and discussions with med-onc and surgeons, and although it is a pissing contest sometimes, at other times it's a pretty cool way to come to a decision.
-You get to spend a very long time figuring out one problem at a time (after hours on the planning system). I'd rather do that than fix multiple problems or try to tie together multiple things.

Later,
Simul