Saturday, December 8, 2007

A Day in the Life of a Pediatric Oncologist

No, not a Beatles song… but rather a look at a typical day for an academic pediatric oncologist. Actually, one of the things I love about my job is that no two days are alike. So there really isn’t any such thing as a “typical day.” Some days, though, see a good combination of clinical work and lab research, so I’ll try to describe what this past Tuesday was like for me.

It’s Tuesday. I get to my office around 9am. The first order of business is checking email (I live on the internet, despite being in my 40’s). Most mornings there are quite a few waiting for me, and this morning is no exception. One email has to do with making some changes to a clinical trial protocol that were suggested by the FDA, so I open that file, make the changes, and send it off to Tammy, my research nurse, so that we can submit the protocol to our Institutional Review Board (IRB). All clinical trials have to be approved by an IRB to ensure that they are ethical, and under certain circumstances (like testing very high doses of a new chemotherapy drug) this can’t happen until the protocol is approved by the FDA.

I answer a few emails, and then I go downstairs to my lab to check on my staff. I spend an hour and a half talking with the folks in the lab about our various research projects. As usual, some are going well, and some are progressing more slowly. I visit each person in turn and we talk about their data from the last week, what it means, how to interpret it, and what we need to do next.

On Tuesdays we have Tumor Board, which is a meeting I run. Tumor Board is the largest regular meeting we have, and is attended by my colleagues in pediatric oncology (including faculty, fellows, nurses, social workers, and pharmacists), as well as by colleagues from surgery and radiation oncology. For the next two hours we will discuss each new patient, review scans that patients have had that require a change in therapy, and talk about the progress of every inpatient. Time permitting, we also have a 20 minute lecture by one of the fellows on a topic relevant to one of the current patients. On Tuesday there were so many scans to review, and the decisions to be made required so much discussion, that we did not have time for the fellow’s lecture. The conversations we had were important, though, because we were able to make treatment plans as a multi-disciplinary group, thus assuring the patients that all of the doctors were in agreement and were communicating well with each other.

After Tumor Board comes the weekly meeting of our bone marrow transplantation (BMT) group. This group typically meets twice a week. On Mondays we talk about upcoming patients, and on Tuesdays we discuss patients currently being treated. As one of my patients is in the ICU, we talk about him for a while. Fortunately, though, he is getting better, and we decide to just hold the course and keep doing what we’re doing.

After the BMT meeting, I stop in to see some of my hospitalized patients. The visit to the ICU is the hardest, because even though the patient is slowly getting better, he is still very sick, and I really want him to get well. I touch base with the ICU staff and discuss his status with them and with the patient’s mother, offering her words of encouragement along the way.

Finally, it’s time to go back to the office. In the last few hours before I head home, I can work on one of the many writing projects I am balancing, including a manuscript describing some new findings from the lab and a draft of a grant application soliciting money to support our lab work. It’s quiet in my office most afternoons, so I get a fair amount done before I go home.

It’s been a long day, so I’m looking forward to being home. Of course, there’s always more work to be done, so after the kids are in bed, I’m sure I’ll get back to work on the grant application. It will be close to midnight before I put that aside and relax for a bit before I go to sleep.


nosugrefneb said...

This is really helpful...thanks. There's always talk about what ratio of research:clinical responsibilities "real-life" MD/PhDs take on among us students, so it's nice to see some different, concrete examples. Would you say you're in the typical 80:20 camp?

Doctor David said...

Hi Ben,
I'm more 70:30, I think, or even 65:35. This issue (ratio of lab:clinic) is one of my favorite topics when people ask my advice... I love to wax poetic when given
the chance.

avi said...

I guess the next question is: are you a "typical" peds oncologist? Are there colleagues of yours who spend significantly more time in the clinic and less in the lab? Anyone who tilts 70:30 the other way? I'm just a curious future doctor (current med student).

Doctor David said...

I'm not sure what a "typical" peds oncologist is. I have colleagues who are exclusively clinical and ones who are exclusively laboratory based. There are also many whose research is clinical, not basic science, which makes understanding this elusive "division of time" that much more difficult. Ultimately, I think everyone settles into their own niche. I'm happy to discuss further. A shame you didn't leave your email address.

Avi said...

Thanks for the reply. Sorry, I didn't mean to be anonymous on that last one. I was at a school computer and didn't bother to log on. And I wanted to clarify from my last post that I will be a doctor in the future, not that I am a doctor from the future, in case I freaked anyone out.

Anyway, I have a definite interest in oncology, but I have just never felt at home in a basic science lab. Of course, I know very well how essential that aspect of this field is, but I always saw myself more on the clinical side, and I was just trying to find out if it was realistic to pursue an oncology career with that in mind. Sounds like... yes? Or would you consider basic science research something that every oncologist should do, at least as part of his training?

Bere:) said...

Hello Dr. David!
I am currently a Junior at Health Careers High School and plan on pursuing a medical career as a Pediatric Oncologist. Are there any suggestions or things that you believe I should be aware of about this particular field, other than how challenging it might be? the schooling?

Anonymous said...

Dr. David,
I am currently trying to decide what to do with the rest of my life. I know what I want to do, I just dont know what profession it is. I want to help kids, make them happy,and let them know everything will be ok. Im not sure what that might be, but I am looking into Pediatric oncology simply because I had a close family memeber go through the trials of glioblastoma. He survived eight years longer than expected. I saw his life, and it inspired me. Do you believe this is the right career for me?

Anonymous said...

I was wondering if there were any pediatric oncologists that only do clinical work and no research/lab portion? Also how do you find your lifestyle at home? Are you a family man? Do you find you have enough time to do what you want to outside your career? What do your hours of work range from?

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Julian said...


I have found your the Day in the Life really interesting, seeing what kind of activities you are engaged with as a pediatric oncologist.

Would you mind filling me in out where you typically carry out your research when trying to decide on the best course of action for the treatment of a patient? Do you take the time to read lengthy articles, or do you prefer reading summaries?

I am working on a research project at the moment to find out what format doctors like their data to be in, and would be extremely grateful for you insights.



Anonymous said...

hi. i was wondering what kind of hours you are at work. i understand you get to work at about nine but what time do you usually get home?

Alexander said...

Hi my name is alexander and im looking forward to be an pediatric oncologist. I just want to know: does a pediatric oncologist have time for their marriage or do they only have time for work? I would really like to know that. Its a nice blog by the way!

Dayenerra said...

Hello!.. My name is Dayenerra. I'm a sophomore at
La Crosse High School. I've always wanted to persue a career in pediatrics but was never sure on what field like cardiology or onclogy ect. So my question to you is "What made you want to be an oncologist? and for that matter a PEDS oncologist?" Thank You =]

Dayenerra said...
This comment has been removed by the author.
Anonymous said...

Hello I had a few questions I'm a senior in college and I got an academic scholarship to the University of Hartford and I'm plan on majoring in pediatric oncology. I wondering if you work in a hospital and do you work with the patients or in a lab? Because I want to be on the job working wtih children not in a lab.pls get back to me ASAP.

Anonymous said...

Am wondering if a 15 year old child who as failed junior high twice still have the opportunity of becoming a pediatric oncologist. thank u

basketballplayer3 said...

Dear Doctor David,

I am a junior in high school in Vermont. I am interested in the oncology field and I was wondering if you felt as if it was worth it to go to school for 11-14 years, rather than usual 4-8. Do you enjoy your job?

jenny said...

Hello Dr. David:

I am interested in pursuing a career in academic medicine. i was wondering if having a Ph.D is a requirement for doing research as a doctor. Is it possible to do a fellowship in research while doing residency?

Thank you


Anonymous said...

this was so helpful! I'm a senior in high school and pediatric oncology is so interesting to me, and im doing a huge final on this profession, and this blog was extremely helpful! Thanks so much!

James Clarkson said...

I imagine being an oncologist is a very stressful, but fulfilling career. Working to cure cancer and other malignant diseases brings a serious workload. However, you have the opportunity to help individuals to overcome life-threatening diseases. Thank you for the great service you provide, may you have the guidance needed to continue having success in the medical field.

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Martin Dineal said...
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