Heme-Onc

So, Heme-Onc is done and I've been trying to organize my thoughts about it. At first I wasn't so crazy about it. I didn't really understand what my job was and what I was supposed to be getting out of the rotation. I worried about the impression I was making. Going back to my clerkships, this is par for the course. I never really like my new rotations until I've been doing them for at least a week.

As I went along I felt like I developed more autonomy. The rotation was pretty relaxed, and I had ample time to read about my patients as I was working them up so that I knew what I was talking about when I presented them. If the consult I did was BS (for instance, a hypercoagulability consult in a patient who had stopped taking her warfarin for a vascular graft), often the patient still had other things going on that I could also read about and learn something from. There were no residents, and the attendings I worked with were very relaxed and interesting in teaching.

The pros about this rotation:
- I liked the practice model. These doctors saw their patients as outpatients, and then were involved in their care when they were in the hospital as well. They also took new consults at the hospital. They had really close and involved relationships with their patients. It felt like "the right way" to practice medicine.

- The science is fascinating. There are a ton of new treatments coming out that have a biological basis. The monoclonal antibodies in particular are growing with leaps and bounds.

- I like the interdisciplinary nature of the field. The heme-onc doctors work with everyone in the hospital from rads and path to surgery and rad onc. All of the sub-specialists as well as the generalists. They end up being uber-hospitalists. They know a LOT about everything. Plus they know cancer.

- I like the culture of heme-onc. The doctors have better relationships with their patients than any others I've seen so far. I like the way they communicate with them. I like that in general they have a realistic and mature way of seeing "the difficult" patient -- i.e. in the context of everything else that is going on with them.

- There is some really interesting research to be done on survivorship and long term side effects of chemo.

The things I wasn't so crazy about:
- I don't find chemotherapy all that interesting, and prescribing these treatments in the outpatient setting is the majority of what these doctors do.

- A lot of what these doctors do is primary care on cancer patients. There are a lot of well checks for breast cancer patients, for instance. I just don't find this type of care very exciting, though it is necessary care.

- Doing heme-onc would require a MEDICINE residency. This is something I've been seeking to avoid ever since the PICK PICK PICK that I experienced on my medicine clerkship. I find rheumatology, ID, and heme-onc interesting, but not the rest nearly so much. And medicine docs tend to be abominably bad at neurology and psychiatry which are very important to me. I don't want to become the doc who tells everybody that his difficult patient with neurosyphillis has a personality disorder. It's just wrong and it happens every. single. day. (The heme-onc docs didn't really do this though.)

- I don't want to end up pigeonholed into running clinical trials. (B.O.R.I.N.G.) As an Epi person, there would be pressure to do this. Also, the heme-onc person in the Epi dept is the one of the one's who won't respond to my emails. This could be a problem in the long run.

So, now I'm onto Rad Onc. It will be very different. I have no idea if I will like it. We'll just have to see.