Variability of expertise within the field

[ghgi8]

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Just a thought...

Everyone knows that there is a great spectrum of expertise amongst surgeons. For complicated cancer operations (e.g. the Whipple Procedure), it is highly desirable to be operated upon under the hands of someone who does this on a daily basis, thus minimizing complications (including fatality) and maximizing success.

I know that there is great variation in disease sites within Radiation Oncology, and that certain site require much more skill/knowledge/dedication. After being exposed to this field, I feel that if I came down with Head and Neck Cancer (knock on wood), I would search out the most capable person of treating me. On the other hand, just like a simple gallbladder or tonsil operation, radiation treatment for cancers like prostate can be exceedingly simple.

I would like to make a list of disease sites in Radiation Oncology that we feel are best addressed by the exceptional multidisciplinary teams available at academic centers.



Requires Less Expertise
1) Prostate
2) Breast
3)

Requires More Expertise
1) Head and Neck
2) Lymphoma
3) Pediatrics
4)

 

[stephew]

actually, i think may would initially agree with your division. however once you practice you'll realize that in fact even "easy" sites actually are fairly challenging in reality. I tell residents that cns is easy for the boards. Very challanging in real life if you want to give excellent care. The patients deserve the multidisciplinary approach. B reast can be very complex too. How do you interpret the randomized trials for the 1980's -which are the major trials- with info we have now? with the ability to detect positive nodes we couldnt before? With herceptin? In the setting of 1-3 positive nodes? When do you do PAB? and it goes on and on. Don't be fooled into thinking these things are answered by rote.

 

[ghgi8]

Interesting

 

[Adawaal]

Gotta agree to some extent with steph here. It's true that it doesn't take a whole lot of skill to do simple breast tangents or a basic prostate plan. But what would you say about the difficulties of the plans from those of us who are doing 10 Gy x5 for total 50 Gy for prostate CA? The planning takes much longer than even the complex NPX IMRT cases. One could argue that nothing could be more mindless than doing a lot of TBI. What of those of us who are doing Tomo-based TMI/TMLI? Talk about hours of contouring and planning....

To be a generalist, following long-established techniques, most things in Rad Onc are pretty basic, requiring only a competent physician and a decent dosimetrist. You can do a lot of good for a lot of people this way, and even make a decent living doing it. But even for the "simple" stuff, there are folks out there pushing the envelope and developing what will be "standard" 10-20 years from now. I kind of chuckle to think that when I'm about to retire I'll run across some young Rad Oncs talking about how quaint and basic prostate SBRT is. Considering what they'll be developing at that time, it will be nice to hear.

 

[stephew]

well its not just technique but decision making i was referring to. When do you choose a certain medical approach and how do you interpret data done in another era today etc?