Rad Onc Twitter

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Fpg1245 said:
If people were gonna adopt it, it would have happened already.
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page what do you mean GIF
 
radmonckey said:
Here's how breast consult goes...

1) Inquire in open fashion what patient has heard about radiation from other providers

2) Inquire if number of treatments has been discussed by other providers

3) Enter this number in prescription and head to simulator
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It should be make clear to referring that treating is decided on a case by case basis.
 
Fpg1245 said:
It should be make clear to referring that treating is decided on a case by case basis.
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Was a joke. I have pretty reasonable referrings who trust my discretion. However, some have their biases and patients on occasion can come in with strong preconceived notions. I always lay out the options and my general rec, but if someone they trust has already planted certain seeds, and the plan is within a reasonable standard of care (there are often several options with general equipoise), it can be best for all parties and the patients psyche to just go with the flow.
 
It's so embarrassing how our field has just been dictated by others what WE should do
And the patients believe the other specialties (my cancer doctor said) oftentimes over us, the radiation people

But we cannot bite the hand that feeds and it takes oftentimes years to change habits
 
RealSimulD said:
Adherence to protocols to the letter is one of the silliest things RadOncs do.

“But Whelan didn’t have DCIS”

Illogical
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Oh I remember those evidence driven idiots who made a point of treating invasive but not dcis in 16 fractions despite the practice pattern in the rest of the world. Just trying to signal that they are smarter than you.
 
radmonckey said:
Here's how breast consult goes...

1) Inquire in open fashion what patient has heard about radiation from other providers

2) Inquire if number of treatments has been discussed by other providers

3) Enter this number in prescription and head to simulator
Click to expand...
Not far off. lol.

I love it when they come in thinking they're getting 6 weeks. "Well, I've got some good news for you."

I hate it when they come in thinking it's radiation or hormonal therapy, one or the other. "Oh boy. Here we go."
 
Thankfully, working in a rural area means:

a. patients dont push for treatments one way or another
b. are generally very respectful of physician directives

exception: when they are affluent/educated enough to go to the big city and are told to do something, they push hard by saying "but big bad center says do this" which most of the time is correct, but occasionally..
 
sirspamalot said:
Thankfully, working in a rural area means:

a. patients dont push for treatments one way or another
b. are generally very respectful of physician directives

exception: when they are affluent/educated enough to go to the big city and are told to do something, they push hard by saying "but big bad center says do this" which most of the time is correct, but occasionally..
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Then go to a big center. I hate those people. They can spend a few days at a hotel and get their 3 fx whatever. Enjoy paying out of pocket for that ****.
 
sirspamalot said:
Thankfully, working in a rural area means:

a. patients dont push for treatments one way or another
b. are generally very respectful of physician directives

exception: when they are affluent/educated enough to go to the big city and are told to do something, they push hard by saying "but big bad center says do this" which most of the time is correct, but occasionally..
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I love treating my rural patients. I have a clinic in the "city" but the rural patients are the best.

None of the 1.5 hour prostate consults that end with "well, sounds good, we'll see what *insert 3-4 other huge academic centers i'm also going to but failed to tell anyone until now* say and I'll let you know what I want to do.

Got it, brother.
 
sirspamalot said:
1.5 hour consults?

kill me now barney stinson GIF
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The longest consult of all time.

Favorable intermediate risk prostate cancer. I considered blocking 2 hours for this specific risk classification of prostate cancer.

If, you really go through a variety of options that each have pros/cons.

Bonus points if you do both LDR and HDR brachy at your institution.
 
evilbooyaa said:
The longest consult of all time.

Favorable intermediate risk prostate cancer. I considered blocking 2 hours for this specific risk classification of prostate cancer.

If, you really go through a variety of options that each have pros/cons.

Bonus points if you do both LDR and HDR brachy at your institution.
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Extra bonus points if you do space oar, space oar vue, and barrigel. Extra extra if you have a cousin in Japan who does Carbon ion therapy.
 
sirspamalot said:
LOL. 2 hours. in 20 years, I've had maybe 1 or 2 with 10 family members asking 50 questions for a borderline terminal patient etc.
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It’s either the ones who have low risk disease or the ones on deaths door that ask the most questions.

Then again I have seen IO given to a dead person once.
 
evilbooyaa said:
The longest consult of all time.

Favorable intermediate risk prostate cancer. I considered blocking 2 hours for this specific risk classification of prostate cancer.

If, you really go through a variety of options that each have pros/cons.

Bonus points if you do both LDR and HDR brachy at your institution.
Click to expand...
TMI
 
evilbooyaa said:
The longest consult of all time.

Favorable intermediate risk prostate cancer. I considered blocking 2 hours for this specific risk classification of prostate cancer.

If, you really go through a variety of options that each have pros/cons.

Bonus points if you do both LDR and HDR brachy at your institution.
Click to expand...
Many of my patients after any explanation longer than 5 minutes
“Doc, I don’t mean to interrupt but just tell me what I should do”
 
Man im just glad i dont treat prostate or breast. Truly da worst! Have you guys ever had a prostate consult so long the patient has to go pee midway (AUA >15) so you thinking standard frac, maybe “go slow” at 1.8!, and you think we haven’t even started treating you and you already gotta pee midway? This is gonna be fun!
 
evilbooyaa said:
The longest consult of all time.

Favorable intermediate risk prostate cancer. I considered blocking 2 hours for this specific risk classification of prostate cancer.
Click to expand...
The money shot consult for established GU chairs at prestige institutions. 2 hours with a rich man and potential benefactor.

Outcomes are good. A life (a rich one) is believed to have been saved (but probably not really).

Private research dollars, endowed faculty positions and sometimes buildings are obtained.
 
thecarbonionangle said:
Man im just glad i dont treat prostate or breast. Truly da worst! Have you guys ever had a prostate consult so long the patient has to go pee midway (AUA >15) so you thinking standard frac, maybe “go slow” at 1.8!, and you think we haven’t even started treating you and you already gotta pee midway? This is gonna be fun!
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I have a lot of breast consults where *I* need to go pee midway. Lol
 
communitydoc13 said:
The money shot consult for established GU chairs at prestige institutions. 2 hours with a rich man and potential benefactor.

Outcomes are good. A life (a rich one) is believed to have been saved (but probably not really).

Private research dollars, endowed faculty positions and sometimes buildings are obtained.
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We have one late career GU doc with an insane ‘research fund’. Well connected with local politicians, and just rakes in the cash.
 
evilbooyaa said:
The longest consult of all time.

Favorable intermediate risk prostate cancer. I considered blocking 2 hours for this specific risk classification of prostate cancer.

If, you really go through a variety of options that each have pros/cons.

Bonus points if you do both LDR and HDR brachy at your institution.
Click to expand...

Yup.

I have spent more time on average with fav int risk good urine function/low AUA symptom score patients than head and necks over the years. Especially if they are engineers, accountants, or architects.

This is patient driven though often. I don't think it's helpful or plan to go through that much. But that above subset (engineers, etc) want to know everything.
 
BobbyHeenan said:
Yup.

I have spent more time on average with fav int risk good urine function/low AUA symptom score patients than head and necks over the years. Especially if they are engineers, accountants, or architects.

This is patient driven though often. I don't think it's helpful or plan to go through that much. But that above subset (engineers, etc) want to know everything.
Click to expand...

Engineers are the worst patients
 
RadOncDoc21 said:
Todays patients are truly the worst. All of them know everything and what they want to do now.
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I’ve always worked far enough from the city or in what’s considered a less desirable hospital. It is remarkable the kind of care you can give and the graciousness you receive in these pockets of America. Truly nice people.

Someone alluded to it: in rural America and safety net hospitals, the RO is still likely to be a US MD, native born and non visa. I think I’m one of just a few here. Not that it’s good or bad, but interesting.
 
This reminds me of a funny story. Literally my first day of residency I was assigned to the GU service. The attending tells me that he has a prostate clinic scheduled for the morning, that I should start seeing patients and he will get there soon.

The first patient was an engineer who walked in with a huge stack of published prostate research papers which were neatly arranged, annotated, and highlighted. He sees me instead of the famous attending he was supposed to see and starts asking questions. He soon realizes that I don't know jack **** about radiation so he asks me, "How long have you been doing this?"

I say, "It's my first day."

The look of sheer terror mixed with disgust on his face was amazing to see - fortunately my attending saved my ass shortly thereafter.
 
Gfunk6 said:
This reminds me of a funny story. Literally my first day of residency I was assigned to the GU service. The attending tells me that he has a prostate clinic scheduled for the morning, that I should start seeing patients and he will get there soon.

The first patient was an engineer who walked in with a huge stack of published prostate research papers which were neatly arranged, annotated, and highlighted. He sees me instead of the famous attending he was supposed to see and starts asking questions. He soon realizes that I don't know jack **** about radiation so he asks me, "How long have you been doing this?"

I say, "It's my first day."

The look of sheer terror mixed with disgust on his face was amazing to see - fortunately my attending saved my ass shortly thereafter.
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Have you thought about finding him and letting him know you're now a top doctor?
 
salubalu said:
Extra bonus points if you do space oar, space oar vue, and barrigel. Extra extra if you have a cousin in Japan who does Carbon ion therapy.
Click to expand...

True true, although I'm usually not giving folks an 'option' for spacing.

It'd be 3 hours if we talked about all RT options +/- spacer...

It's not my place to tell the patient what is better or worse for them if I'm discussing a number of options that are all equally correct. Give the information, help them to make a decision. Only if they point blank ask me do I tell them - usually not surgery, usually mod hypo vs conventional based on their distance from the facility.
 
1) to @RealSimulD's point, I realized last week I seem to be the only MD-PhD at my hospital. Now, before the ghosts of the founding physician-scientists roll over and haunt me, this also means I took over as the local RTOG PI...so it's safe to say I "physician-scientist so hard" I reached back in time to become PI for an organization that no longer exists. Eat your heart out, Flexner!

2) I have stratified my "engineering dread" based on sub-culture.

Environmental Engineers are the worst. Electrical Engineers are a close second.
 
elementaryschooleconomics said:
1) to @RealSimulD's point, I realized last week I seem to be the only MD-PhD at my hospital. Now, before the ghosts of the founding physician-scientists roll over and haunt me, this also means I took over as the local RTOG PI...so it's safe to say I "physician-scientist so hard" I reached back in time to become PI for an organization that no longer exists. Eat your heart out, Flexner!

2) I have stratified my "engineering dread" based on sub-culture.

Environmental Engineers are the worst. Electrical Engineers are a close second.
Click to expand...

I've had a post-doc in nuclear engineering as a patient. Actually a pretty cool guy and was confident in our plan... we talked mostly about what can go wrong on a submarine
 
Lamount said:
I've had a post-doc in nuclear engineering as a patient. Actually a pretty cool guy and was confident in our plan... we talked mostly about what can go wrong on a submarine
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Oh yes...I've practiced in areas around Navy bases/nuclear plants....they always ask their dose in Sieverts.
 
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