Day in the Life: Medical Oncology

I'm about halfway through my three-month rotation in medical oncology. So far it's been fantastic...but very confusing. There are so many chemo regimens, hormonal therapies, biologic therapies, and clinical trials. For each drug there are side effects, interactions, dose adjustments, and modes of administration (oral, IV, PICC) to consider. Huge props to the medical oncology residents for learning it all in just two years (but they're cleverer than us, having survived three years of internal medicine). If I can start to wrap my head around just the first-line drugs (forget the second-, third-, fourth-, or fifth-line options) in the weeks to come, I'll consider this a successful rotation.

I'm scheduled to spend a bit of time with each of the medical oncologists this rotation, which means I'll ideally see a little of every kind of cancer. Here's what my days typically look like:

0730 h: I get to work a bit early to do a few computer tasks (emails, signing off on transcribed dictations). Usually I've already looked up and made notes on any new patients we'll be seeing in clinic.

0800 h: I attend new-patient rounds, where the oncologists, pathologist, radiologist, and research nurses discuss management plans for the cases that we are about to see in clinic.

0900 h: I join a medical oncologist in a new-patient clinic. We typically see three new patients; spending about an hour on each consult.

behind the scenes in clinic

1200 h: About 50% of the time clinic is done on time and I can make it to rounds; each noon-hour there is a different kind of rounds, usually some kind of lecture or discussion of new patients.

1255 h: I find a few minutes to eat my lunch, if I haven't already.

one of my more effortful lunches

1300 h: I join a medical oncologist in a follow-up clinic, seeing for the most part patients who are on chemotherapy. We check over their bloodwork and assess them for chemo toxicities. Occasionally patients require bone marrow biopsies, which the medical oncologists perform themselves. I am a little less horrified by bone marrow biopsies than I used to be and even did one myself the other day (despite really really not wanting to...faking confidence is key).

where it all happens; that whiteboard is the best part of the room for visual learners, like me

1700 h: Generally clinic is over by this time and I head down to the residents' room to get caught up on computer tasks, look up patients for the next day, hang out a bit with the other residents, etc. I usually head home by 6 pm.

In the background, I'm taking medical physics (well, simplified medical physics for radiation oncologists) classes twice a week, working on my research project, and studying for an upcoming exam, so the days have been busy, but not too taxing.

I'm quickly seeing that medical oncology is a more interesting specialty than I'd previously thought. Medical oncologists aren't just glorified druggists; they have to be good clinicians to be able to assess a patient, select an appropriate treatment (if any), know when to stop it (if toxicities are too significant or if the disease is not responding), and decide what (if anything) to try next. Besides being clever, they must excel at communicating on both technical and psychosocial levels. It's an interesting specialty that will certainly see evolution in the years to come, as cancer treatment moves in the direction of targeted and biologic therapies.

If you're a medical student, a medical oncology elective would probably be worthwhile (if only to see how a cancer centre works). Logistics-wise, in Canada you can't enter directly into medical oncology after medical school -- it is an internal medicine subspecialty, meaning that you would do three years of internal medicine, followed by two years of medical oncology.