stephew said:
im not quite sure how to address this. Its a very multidisciplanry field but of course you act in the best interests of the patient. However you, the surgeons, the med oncs etc will need to be in close communication in order to work for the best interests of the patient. Frankly in real clinical work there is little that isn't multidisciplinary. Perhaps the bigger differentiation is rather are you talking more with other clinicians or with both clinicians and pateints (ie the diff between radiology and radonc).
I think this is true to a great extent and is in the best interest of the patient. RadOnc is, to a very large extent a secondary referal specialty. You will be consulted by surgeons, gynecologists, internists and medical oncologists. You need to be attuned to their concerns and interests and be able to explain your specialty to them and why it is important for them. All too often radiation therapy is thought of as the "treatment of last resort" in some smaller communities or the radiation oncologist is thought of a the "pharmacist of radiation." Ie we decide, they deliver. This is changing, but the attitude still exists.
Radiation oncologists in the history of medicine before effective chemotherapies came about were "the" oncologists. We did more inpatient procedures (LDR brachy), were more available for after hours consultations, and generally were who the more primary doctors called for cancer questions. That role is being suplanted by the medical oncologists to some extent, and in some institutions to a great extent.
Once you have been consulted, you do have the autonomy to decide how to treat the patient, (dose, fraction, modality, elapsed time, and all the variables peculiar to the specialty), you follow the patient frequently during and post treatment, and coordinate with surgeons, medical oncologists the type and nature of additional medical or surgical treatments. So, you do have much patient care autonomy.
So, to do well in the field, you do have to be able to work cooperatively in a disparate multidisciplinary field, since that's where the referrals come from. You have to be diplomatic to stand your ground, amicably when a colleague from another specialty insists that their patient needs radiation when the evidence clearly indicates another path is best and be your patient's advocate for radiation treatment when the evidence demonstrates it to be the best treatment. Sometimes this is a very difficult tightrope to walk.
And be nice to your physicists! They'll save your life!
