Divergent paths

Three medical oncologists talk about their journeys into their chosen specialty

MEET three medical oncologists who took three different pathways into the same profession, and now work in three completely different ways.

Science degree first

Dr Miles Andrews is 34 years old and did a science degree before transferring to postgraduate medical studies at Flinders University in Adelaide, finishing in 2005. He’s now a senior staff specialist at Austin Health in Melbourne, focusing on melanoma.

“Oncology was definitely always high on my list but I kept an open mind through med school and was open to all the possibilities”, he tells the MJA.

Dr Andrews describes himself as a “lab rat” and sees translational research as a big part of his practice, and his future, but clinical work is also a passion.

“I love it”, he says. “People find out you’re an oncologist and they often say ‘so depressing’ and that’s an understandable reaction, but I don’t really focus on the poor outcomes, or the suffering or that everyone thinks all our patients die – which is not true.

“The fact is everyone dies of something – it’s more important to change the focus, the way we die, and the experience of dying.

“I embrace having those difficult discussions with patients and their families.”

Learning to have those conversations is part training and part experience and observation, Dr Andrews says.

“It’s very important to learn from watching others.”

Dr Andrews has chosen to work in the public system because he believes it is easier to do the kind of translational research he wants to make his life work in the setting of a public hospital.

“There’s a more academic component to the public system”, he says. “I like working with trainees and other consultants, and it’s easier to do clinical trials in that setting.”

Dr Andrews is hoping to spend a couple of years overseas, most likely in the United States, doing postdoctoral work. Long term he’s aiming for a translational appointment in a large public hospital back in Australia.

Work-life balance

Dr Yoland Antill is 48 years old and graduated in 1996 from the University of Newcastle. She is married and has two children (the youngest in 9 years old).

She splits her working life between the public and private systems, and treats cancer patients from diagnosis to end-of-life. She also does research and clinical work in cancer genetics as part of the family cancer clinic at Royal Melbourne Hospital.

Her public patients are centred in Frankston, on Victoria’s Mornington Peninsula, while her private practices are in the leafy, affluent bayside suburbs of Melbourne’s southeast.

“There are huge differences between my different practices”, Dr Antill tells the MJA. “I love those differences.”

Her Frankston patients tend to be elderly, immigrants, often socially isolated.

“There are financial inequities, as well as drug and alcohol issues”, she says. “It’s not that unusual for a single parent to die, leaving their children as orphans.

“That just doesn’t happen in private practice.”

Because she did all her study and training in New South Wales, it was difficult for Dr Antill to find work when her husband’s work brought the family to Melbourne, a city with which they soon fell in love.

“I spent a lot of time finding my place but I chipped away at it”, she says.

“I was doing maternity leave locums and then a surgeon in private practice approached me to go into his rooms in southeast Melbourne as a medical oncologist. It was a great opportunity.”

Then her husband’s work took the family overseas. When they returned after 6 months, they decided Dr Antill would become the main breadwinner while her husband spent 18 months at home with the children.

“I needed to ramp up my income”, she says.

She took the Frankston Hospital public appointment and also set up in private practice again.

Today she works within the Cabrini system, looking after patients from diagnosis through to end-of-life, working in collaboration with surgeons.

“It was conscious decision to care for patients from beginning to end”, she says.

With her time split between her public patients at Frankston, her private patients at Cabrini and her cancer genetics work at Royal Melbourne Hospital, it’s amazing that Dr Antill also finds time to teach students through the Cabrini Institute.

“It’s a busy life but I feel very strongly that I don’t want to give up public appointments”, she says.

Her genetics work holds special excitement for her.

“We’re on the crest of a wave at the moment in terms of advances in the genetics of breast, ovarian and colorectal cancers”, she says.

“We’re identifying those people who have a hereditary risk and out of that is coming a wave of targeted therapies.

“It’s all about prevention. If we can do genetic testing for families and can identify individuals with increased risk then we have the opportunity to undertake strategies aimed at reducing their risk.”

Now she and her husband are working fulltime again, Dr Antill says they have brought a young couple into their family as nannies to their two sons.

“I love the idea that the two boys can see it’s not up to one gender to raise a child. There are many ways to skin a cat and they will really benefit in the long term from learning that if they want what we have in our lives – a nice place to live, holidays, all that – then Mum and Dad need to work.”

Rural GP to paediatric oncology

Dr Molly Williams is 36 years old and graduated from the University of Melbourne in 2005. As a senior staff specialist in paediatric oncology at Royal Children’s Hospital in Melbourne, she is a long, long way from where she thought she would be as a medical student.

“I was going to be a rural GP”, she tells the MJA.

“I did as much training in the country as I possibly could. Then I decided to do a year of paediatrics training to make sure my skills were fully rounded.

“One week into paediatrics I was hooked. It was so much more fun. It also felt like that even as the most junior doctor I was able to make a real difference to the patients.”

Even though she decided not to commit too early to paediatric oncology – “I tried to stay as general as possible” – in the end she couldn’t resist.

“It was like The Sopranos”, she says. “They pulled me back in.”

But surely working with very ill children can be depressing?

“It can be very sad”, Dr Williams agrees, “but what I’ve learned is that those extremely difficult times can be made tolerable by taking a human approach as a doctor.

“We love the patients – it’s an intense commitment.

“I’ve found that by putting my energy into establishing that relationship with a patient, I get an extraordinary amount back.

“It’s fun, challenging, intense, prolonged and the medicine is mind-blowing. It’s an exploding field.”

As part of her advanced paediatric oncology training Dr Williams spent 6 months in palliative care, which turned out to be a career-defining experience.

“It was an extraordinary thing to do”, she says. “It’s completely different from oncology practice. You’re in the patients’ homes, even the power balance is completely different. It’s an opportunity to be as personal and honest with patients as we could be.

“If we have the courage enough to be honest, it makes them trust you more, and if anything, gives them more hope.”

The pairing of oncology and palliative care is a “great marriage”, Dr Williams says.

In 2014 she undertook a pilot project creating a model for the early integration of paediatric oncology and palliative care that included research into advanced care planning in paediatrics.

How do you talk to young children about dying?

“You create a safe space for the child to ask questions, address any misconceptions, and allow them to express their fears”, she says.

“Kids have very different fears about dying than adults do. I had one young boy who was really worried about not being able to take his library books back. Once he was reassured that that would be taken care of, he was much less afraid.”

It’s a career path Dr Williams very much wants to pursue to its logical conclusion.

“Ideally I’d like to work 50-50 in palliative care and oncology”, she says. “My real interest is in supportive care, and Gestalt care for families.

“My patients teach me stuff every day. If I could have a quarter of their grace and dignity, I would be very happy.”