SPEAKER_03

I feel like I'm with John Laws.

SPEAKER_02

You feel like you are John Laws?

SPEAKER_03

No, we're John Laws.

SPEAKER_02

I'm John Laws in this. I'm the John Laws in this in this situation.

SPEAKER_03

The goal with the golden tonsils.

SPEAKER_02

I don't think anybody has ever described me like that. You're listening to On the Moans, where we have conversations about hormones, midlife, and the moments that make us wonder, is it just me? I'm Kate. I'm a 48-year-old pharmacist and newly minted perimenopausal oversharer. This is where we talk openly about the changes we aren't prepared for, so we never have to feel alone in them again. I acknowledge the Camaragle people of the Eora Nation, the traditional custodians of the land which I am recording today. I pay my respects to elders past and present, and I extend that respect to all Aboriginal and Torres Strait Islander peoples listening. Always was, always will be, Aboriginal land. Hello friends, welcome to On the Moans. Today we're doing something a little bit different. Instead of talking about menopause or hormones, or the latest wellness trend, we're going to step behind the curtain of modern healthcare. My guest is medical oncologist David Thomas. He's spent more than three decades caring for people with cancer, and in this conversation, I wanted to understand what the job is actually like. What does a typical day look like? How are treatment decisions made? Who are the people sitting around the table in these multidisciplinary meetings we hear so much about? And what keeps someone coming back to a job where they spend day after day supporting people through some of the most challenging moments of their lives? We talk about teamwork, difficult conversations, the importance of good colleagues, and why cancer care is never the work of a single doctor. Most importantly, we talk about the privilege of being invited into people's lives at a time when they are vulnerable, frightened, and searching for hope. So if you've ever wondered what a medical oncologist actually does all day, or why you've had to wait so long in the waiting room, or you've found yourself navigating a healthcare system as a patient, family member, or friend, this conversation is for you. Here's Dr. David Thomas. My first question to you is going to be you've been a medical oncologist for 35 years? Is that right?

SPEAKER_03

No, I don't think so.

SPEAKER_02

How long have you been a medical oncologist for?

SPEAKER_03

Um 20. 20 in a bit.

SPEAKER_02

Oh, because of all of your pre-training. You've been a doctor for 35 years.

SPEAKER_03

I've been a doctor for Oh goodness. 30 years? Yeah.

SPEAKER_02

30 years. But you've been a medical oncologist for 20 years.

SPEAKER_03

Let me just calculate that. Yeah, 95. Since 1995. The nineties were good.

SPEAKER_02

So you've been a doctor since 1995.

SPEAKER_03

Yeah. But you know, as an intern and trainee.

SPEAKER_02

Yeah, so that that counts. Yeah. But a medical oncologist for 25 years. So my question 20. Sorry. I can't help but age you. A medical oncologist for 20 years. So my question to you is why did you not choose dermatology? Because it seems to me like you've chosen the most emotionally fraught specialty when you could have been telling people just not to eat avocados.

SPEAKER_03

That's true.

SPEAKER_02

Sorry to all my dermatology friends out there. I've completely just oversimplified your amazing your amazing knowledge and your amazing career.

SPEAKER_03

And I don't mean that, but you understand what I'm trying to say is how on earth do you choose For example, my my one of my besties is a dermatologist.

SPEAKER_02

How is it that you settled into oncology given the what I suppose from the outside looks like?

SPEAKER_03

Quite a grim well, I had um lots of luck. Um, like all these things. I was doing my basic physician training, and as part of that I did uh some palliative care, and the palliative care seemed to suit me, and I had lots of very good mentors within that space. Yeah, I did um so I did uh a fairly extended sti stint as a palliative care registrar, and as part of that I had I had a number of really amazing mentors at the hospital I was um training at. And one of them um was both a palliative care physician and an oncologist, and was really, really wonderful and pulled me across to oncology. And I thought I was pretty suited to palliative care at the time, uh, and but it was nice to be uh I guess trained in oncology because you had you did some of the palliative care. I I I um I think now we're very fortunate because I've got wonderful palliative care colleagues and they've got amazing expertise, so we don't have to fulfill that role. And you can be uh an oncologist and be both, you know, an active um clinician, uh treating cancer, and you can still um utilize some of those skills. So it was yeah, I think it was the I I was fortunate because I just seemed to run into the right people. And I was uh fortunate because of the just that sequence. Yeah, and and when I think back on that, I um and I I tend to say this to our trainees that the palliative care experience, if you can you know, get as much advice from that though those specialists uh and you know gather skills in that um direction you're you're doing well for your oncology career always.

unknown

Yeah.

SPEAKER_02

Because you would think that they would be natural bedfellows.

SPEAKER_03

They are, and we where I you know, where I work, they we're sort of um uh peas and a pod, so we do tend to work really closely together. I think that's the same at you know most most hospitals. Um and it makes the care of patients um, you know, as as good as it can be.

SPEAKER_02

So take me through a typical day being a medical oncologist. But actually, before we do that, perhaps what I might get you to do is explain the difference between medical oncology and radiation oncology.

SPEAKER_03

Uh yeah, so so there's broadly you can um in oncology you can push people into three different groups. God, I hope I don't miss out anybody. But you um uh there's uh surgical oncologists who work in lots of different um surgical fields, but you know, all dealing with cancers. Uh there are radiation uh oncologists who treat cancer with radiotherapy, so that's really I guess most you could describe it as most crudely as really strong focused x-rays. And medical oncologists are treating cancers with uh combination of different drugs, but some chemotherapies, targeted, what are called targeted therapies, immunotherapies, hormonal therapy, but it's generally medications um that uh, you know, do the task of either controlling and managing cancers or or killing cancers. But everybody's working together as uh, you know, well, trying our best to work together as uh a big team. So I I'm part of uh numerous um teams within uh our cancer care center, and they all involve those groups, but they also involve some um specialist radiologists, uh interventional radiologists, nuclear medicine doctors, pathologists, and then allied health, so specialized nurses. Um so those teams um and I'm gonna miss out people, but uh also my um you know I I shouldn't miss out, um palliative care, you know, those teams um make complex plans for treatment for each type of you know, each individual patient with an individual cancer. And we try to make our plans as individualized as they can be.

SPEAKER_02

So a term that people might hear is MDT or multidisciplinary team, and I think that's what you were just describing. And I always imagined the MDT meeting to be like the sit room in the West Wing in the White House when everybody gets together in a darkened room and you sit around a table and it scans up on the projector. Is it anything like that?

SPEAKER_03

Well, for a little while it was. Um we would gather in um You can take that to your next MDT too, by the way. I think Yeah, the sit room. Um Well, you know, for a little while it was, and so you know, when I was a trainee, we just push a very big trolley of x-rays into a a darkened room, and then we'd gather around light boxes and we'd put up X-rays and C T scans and MRIs.

SPEAKER_02

Time to do that.

SPEAKER_03

And we and we'd present patients and there'd be uh a cluster of you know of uh surgeons and you know um radiologists and uh radiation doctors and medal, you know, medical oncologists, and we'd all be um gathering together to make plans. So it was it was a both a a really good way to do it because it was very personal. Uh so you've you know you there is nothing like uh speaking, you know, to to each other, you know, face to face. Um the downside, of course, is that you do have to get home and you do have to leave the hospital and you do have to come at um also arrive at ungodly hours when only surgeons and anesotists are really inhabiting. I think the main drawback is that most most meetings are before and after hospital, and you can't have the you know, not everybody's able to to to be there. You've we'll have at some point in time little kids and we have to be home, and um and then you know there are some meetings where it's that godforsaken hours where only anaesthetists and surgeons seem to be awake. And so the only really good thing that came out of COVID was that um we do most of the meetings now by um Zoom or by health teams.

SPEAKER_02

And so You do it, you do it by Microsoft Teams.

SPEAKER_03

We do it by Teams, yeah. And the good thing about that is that you we just have a much we can have uh you know pathologists presenting, we can have um uh interventional radiology and x-ray doctors uh commenting, we can have multiple opinions um from uh you know from med the all the um people attending and we'll just get a much bigger uh array of people. I think people are much more much more able, enabled to have an opinion in that setting.

SPEAKER_02

So you present your own patient. Which how do you get on the how do how do you as a patient get into this sit room of specialists?

SPEAKER_03

Yeah, you know, it's essentially you act as the advocate for your patients. So you take patients to um meetings to present and ask questions, and uh you might ask questions about the pathology or the radiology and just the options for management, but the idea is that you're getting an opinion from the team regarding you know best management, and it may mean incorporating a surgical approach or interventional radiology or or radiation oncology approach, and so you'll bring people into the care of your patient, but you're acting as the advocate for your patient, and uh you know, I'd I'd ideally um giving them their absolutely the best um care.

SPEAKER_02

Amazing ex exposure to a whole bunch of people and their expertise that they may not have had. And typically you see somebody in your clinic and you think it would be good to get the MDT.

SPEAKER_03

Yeah, I think all of us um would um I think it's probably would be nearly the majority of our patients that we'd present in those meetings. Uh and so, you know, those meetings, you know, sometimes they can be quite long, but you they're they're all very good because you have the opportunity to actually um help your colleagues by contributing your opinion. You also you learn, you learn because you um you'll you'll hear the thoughts of your colleagues. So it's uh it's like having a further opinion. Uh I think it encourages your own confidence in the actions that you're taking and you're able to also pass that on to your patients. So, you know, look, I've I've discussed this with my team, you know, members. I I think you know, I see um patients within the clinic, but they may not be aware that there's a lot of discussion in the background, that there's time spent in you know meetings talking about their scans and talking about their pathology.

SPEAKER_02

And so how many MDTs would you attend each week?

SPEAKER_03

I think I attend approximately four.

SPEAKER_02

Four multidisciplinary team meetings in a subspecialty of your specialty?

SPEAKER_03

Uh in yes, in a sort of super special specialization. So it might be there's always something on Monday night, and when there's not, it's actually kind of a nice day because you've finished on time. What's on a Monday night? And Monday nights often um we have you know alternating weeks where it's upper gastrointestinal cancers, so that's things like pancreas cancer and esophageal cancer, and it's a really well-attended meeting, it's really, really valuable for me, and uh, you know, I really value the opinions that are given there. And then Tuesday's off um again alternating, but it's um colorectal cancer, and so again, it's it's for quite a particular situation, but there's lots of discussions about integrating intensive chemotherapy and radiotherapy. Uh, and then Wednesday is again is alternating between melanoma therapy and uh again gastrointestinal cancers, but particularly liver cancers. And then Thursday is alternates as well, and that's about brain cancers. And that again is a really terrific meeting, it's really well attended, it's got a sort of cast of many surgeons, um, and we have a great uh, I guess, a great combination of very, you know, really capable, really terrific surgeons and uh terrific radiation oncologists. So and we're devising plans for people who are really in um the toughest, you know, um moments in their life. So Friday is um again on alternating weeks, but it's uh um neuroendocrine tumour MDT, and it it's really very specialized. Uh it's um is a meeting that I really enjoy because it incorporates uh a number of people that um are from different teams from medical oncology, surgery, interventional radiology, nuclear medicine. Uh, we've been working together for a long time, and um I think we all appreciate that it's um an area that we make a difference at so yeah, it's a it sounds like it's a busy week.

SPEAKER_02

Um it sounds like it's a hugely busy week, and I guess I'm sitting here wondering how you get anything else done. What is a typical So choose your favorite day of the week or your least favorite day of the week, and explain to us how that day is run. Because I'm guessing on top of all of the so you've only spoken to us about multidisciplinary team meetings, but you'll have inpatients, you'll have clinics.

SPEAKER_03

Um so I think um it's a mixture. Every day's got the good and good and the bad. So I'm part of a big team of um oncologists, so and we cover um two hospitals but between us, and at any one time there's three of us covering the wards and another hospital, and somebody being on call, and then there's um people covering the private hospital. So there's always a degree, you um, you're always doing some cover uh for inpatients, and uh we all do a mixture of clinics through the week, so that's outpatients clinic, outpatient clinics where you see a whole bunch of um people who are living with their cancer, they might be having um treatment with um a cure in mind, they might be having treatment with palliation in mind, uh, and you are seeing each person, they may have vastly different um problems. So some people come in and it will be really simple, and then other people come to see you and it'll be incl incredibly complex.

SPEAKER_02

And these are people coming in from home, yeah.

SPEAKER_03

From home with family members. We're really dependent on our uh advanced trainees who see patients with us, and so there's uh some teaching that goes with that. There's a lot of uh uh discussions about um what what's to be done now, what's to be done next, where a person is in their sort of journey. I think uh my colleagues would share very similar experiences. Um we all look after different cancers, they could hear, and so we have focuses um on different cancers. And when I was just a younger doctor, we used to look after all the different types of cancers and even some of the blood cancers. It was partly because the knowledge of cancer was not as great and therapy wasn't as good. But with knowledge increasing, therapy improving, becoming more complex, uh between all of us, we um focus on different uh, I guess, organ systems. Um, and so we have different associations with particular radiation doctors and surgeons who look after those um systems.

SPEAKER_02

Um So you're a specialist oncologist, medical oncologist, but within that specialization, you are focused on super specialized on Well, you focus on well, with me it's focus on uh gastrointestinal cancers.

SPEAKER_03

Um that probably um makes up most of what I do, but also uh I look after this particular, I guess, reasonably um common cancer called neuroendocrine tumours. I look after um nervous system tumours and I look after patients with melanomas. So it's there's still a breadth, and I think all of us have that kind of breadth to our practice.

SPEAKER_02

But if I have a breast cancer, I don't come and see you. No.

SPEAKER_03

No, no, no, and and you know, we because we're on call um at at um at different times we'll see patients who have cancers that you know we may not be as comfortable with looking after. So we'll um ask our colleagues who do look after those cancers.

SPEAKER_02

Yeah, so you might absolutely called in the middle of the night to someone with a breast cancer, but then the next day you're handing that back over to the breast cancer special specialist.

SPEAKER_03

Yeah, yeah, absolutely.

SPEAKER_02

What what is a typical day looking like for you? Or like give us a typical Friday.

SPEAKER_03

I'm gonna go with Friday because it's got some good stuff and some bad stuff. Uh well, not bad stuff, but it's got there's some hard things in it. So the good stuff is I usually get up and I try to do some sort of exercise. That's always good.

SPEAKER_02

That's important for your mental health.

SPEAKER_03

It's good for my mental health. And I then head in, and when I go in, I usually get a coffee. And I usually almost always bump into nurses from our ward, the oncology ward, so I say hi.

SPEAKER_02

Oh wait a second, wasn't there a meeting on Friday? I can't remember which one.

SPEAKER_03

That starts at eight. So it's at a it's actually at a kind of almost normal time.

SPEAKER_02

So this is all happening before eight o'clock. Yeah. Before your day officially starts at eight o'clock.

SPEAKER_03

And then I usually get cakes and donuts and stuff for the clinic because I f I feel like I need I I owe it to everyone because my clinic's a little bit chaotic. And um That's for the staff. That's for everybody. Oh, for the patients as well. I don't know. I think they might take a few things. Yeah, yeah. But it's very, yeah, for everybody with cardiovascular disease, not really good.

SPEAKER_02

So sorry, we're only up to 8 a.m. and you've bought coffee and running passengers.

SPEAKER_03

Yeah, and I so then depending on the day, and there might be a meeting at um at 8, which would be uh an MDT, and that's actually it's really good. It's just that it's usually sort of running into other things. Again, for for myself and my colleagues, if we're on call and covering the wards, then we have to sort of think, oh gosh, how are we going to see go out to the ward? We've got wonderful physician trainees who run the wards uh with our junior medical um staff. There these are the interns and residents and registrars, and they're they're amazing. And we've got a ward that's also incredible, very just an amazingly experienced um nursing staff and and um allied health.

SPEAKER_02

So we've got a ward that just so you you feel comfortable if you're on for that ward and you're not physically on that ward that they're making good decisions and if they need if they need to run a decision past you, then they will know.

SPEAKER_03

Yeah. And I think we've just got such experienced nursing staff that um, you know, they know when um when problems are uh, you know, brewing, when you know issues are are occurring with patients, and I think it it um you know just makes the care really uh really really amazing.

SPEAKER_02

And why would you be an inpatient?

SPEAKER_03

What so you might be an impatient for a few reasons, but it's um you can broadly say it's patients coming in because of complications of their cancer. So they've got a cancer-causing pain or yeah, so symptomatic concerns, or um it may be maybe you know actually creating uh physical, mechanical problems, um, blockages and uh or creating you know infections as a complication of that. There's patients who those patients really benefit from the input from palliative care. So palliative care of a big presence on the ward. The other group are patients who are on treatment and they're getting complications from that treatment. And I think we see that that's become more complex because we give a particular type of treatment called immunotherapy, which has made our care again vastly better for a lot of different types of cancer, but it has created uh uh also its own complications, and they they are sometimes really uh they're difficult, difficult to manage, but they also require, and I think this is a good thing, they often require the input from our other colleagues from other subspecialties, so gastroenterology, renal medicine, cardiology, and sort of ties people together, which is you know, to ties their or you get a greater degree of cooperation within the hospital, which I think is always good. I I think you can broadly put people into those two groups, you know. Problems from the cancer, problems from treatment, and people can um, you know, um a lot of people have very extended stays in hospital. Um I I just always um you know marvel at um what we're able to do. I think that the you know the ability to remedy complex pr problems is is amazing.

SPEAKER_02

Magic.

SPEAKER_03

There's also people who um you know are unable to recover. And again, it's where we've got that that backup of palliative care to both manage symptoms, but it's also to manage end-of-life care as well. And I think where that's where you know where we've got that co again, that cooperation, we've just got you know, really again, very talented nursing and medical staff, you can make a big difference to people. And and to their families. I mean, that's the other, I think the other thing.

SPEAKER_02

So if we're up to 8 a.m.

SPEAKER_03

Oh yeah, yeah, so eight, eight, um, so and uh Oh no, you've you've done the meeting by now, so maybe now it's nine, nine thirty. And so then the day does get a little crazy because there are you know the clinics uh I I So you go from wherever it is you attend the meeting to now the the space where we're in the cancer care centre and there's an outpatient's clinic. And at the same time as I run my clinic, they've got uh a number of colleagues running their clinics as well. And that's great because you've kind of again it's there's a little bit of camaraderie, and we all um you know you can talk to those colleagues along the way.

SPEAKER_02

How many people are you seeing in this clinic typically?

SPEAKER_03

Probably at least 20 patients. This is just the morning? And this is a bit of the morning stretching into the afternoon. Okay. So, and I'm given to talking a lot. So my I'm I unfortunately I'm just just not not very good at remaining on time, but I also look after particular tumor streams where you know it uh it can be complex, and I think we have long conversations, and I'm uh they don't sound like conversations that can be done in 10 minutes. No, no. And there's often tasks that you have to do that you know require m much more time outside of the actual face-to-face discussion. So we have again, I just emphasise we've got amazing allied health. So that you know, we've got people from dietetics who are amazing, who uh for our gastrointestinal um patients, uh keep people on the straight and narrow, make everybody, you know, keep keep everybody's spirits up. We've got um people from clinical psychology um looking after uh patients and their and their families. We've got uh nurse specialists who are just nurse practitioners? Um nurse practitioners, but um you know we've got amaz essentially amazing uh nurses looking after again, it's it's outside of that 15 or 20 minutes of discussion.

SPEAKER_02

It's so if I'm if I'm a patient in your waiting room and I come to your outpatient clinic, so I'm sitting in my chair, I've checked in with reception, just so they know I'm there. I'm sitting in your I'm sitting in the waiting room. What is what's going to happen to me? You're gonna come and say my name, or do you have help? Will I see your registrar?

SPEAKER_03

Um well, some people will see me. Um well, most people will see me, but a fair proportion will see my registrar. This is again amazing. And they'll uh, you know, devise a plan and and then we'll discuss that plan and see if there's any um you know anything that's else that's needed to be to to be done. Uh and then it's a case of just organising, you know, what's what's going to happen next? Is it about treatment? Is it just about symptomatic um care? Do we have to link um the patient up with community um teams? Um, you know, what else is going to actually or I might see the dietitian, yeah. Yeah, absolutely. There's um gosh, I've I've missed out speech pathology. Yeah, OT, whatever it is. Yeah, yeah, absolutely. Physio, whatever it is. Whatever's, you know, whatever's required.

SPEAKER_02

You might write a prescription for something.

SPEAKER_03

Quite a few prescriptions.

SPEAKER_02

Quite a few prescriptions.

SPEAKER_03

Quite a few prescriptions. Um so it's keeping people moving on that journey, whether it's about treatment that's been given following surgery with the you know intention of reducing risk of recurrence. So if it's um treatment that's been given before surgery with again with the idea of you know improving their chances of cure, uh, or whether it's treatment that's been given with a palliation in mind, a palliative intent to to see if we can give people more time, a better quality of life, um, all of those, um, that they're they're sort of general streams of of care. But to do that it requires lots of people, um, lots um and a lot of a lot of thought and and you know not not just from myself but just from you know multiple um individuals but working together as a team.

SPEAKER_02

It's yeah. So I think people uh probably have a vague understanding of what it is to sit in a waiting room and then see the doctor because most people have seen a GP. Yeah. So they're familiar with that sort of process. But I think what people don't understand is that I mean, none of what you've just described to me sounds like a conversation you could have in 15 minutes for a start, but then also the amount of follow-up that happens once that person's left. So you your 20-person clinic isn't 20 lots of 15-minute consults, it's actually a huge amount of background work, is is what I'm hearing you say.

SPEAKER_01

Hmm.

SPEAKER_03

I yeah, I think so. Um I think the better you, you know, the to do it well, I um you know, I think it does require a lot of it requires a lot of people. Yeah. You know, you just it's just impossible to do it as a as an individual. And we're just, you know, I I think we're fortunate. Uh where I work, I'm I'm fortunate, but I know that that sort of team approach is pretty much as standard. And uh I think we're I think we're very proud of it, again, where I work, that we, you know, have um have some really good, you know, really terrific teams.

SPEAKER_02

So now now are we up to lunch? Now we're up to lunch, but it sounds like we're late.

SPEAKER_03

So I have yes, I um I have a Do you ever have lunch?

SPEAKER_02

Do you ever get lunch?

SPEAKER_03

I have a uh I have uh a yogurt and measli which sits on my table until about three o'clock.

SPEAKER_02

Oh, that that sounds delightful, warm.

SPEAKER_03

And uh I think I might grab a second coffee at about 3 30. But normally afterwards it's a case of seeing, you know, it'll be catching up with consults, maybe seeing some patients again at the private hospital. It'll be trying to sort of finish the um admin tasks yeah, finish the week. Uh it's um I think it can be sometimes the you know uh the best part of the week because I I really like going to the ward and I like um I I think we have just you know wonderful um young doctors looking after the patients. So I really enjoy um just seeing the patients with them. Uh I'm very slow, so they probably don't enjoy that at all. But I that that that's a really good positive part of the day.

SPEAKER_02

I imagine if you're a patient, like thankfully I've never been an oncology patient, but I imagine if you are an oncology patient and you're lying in an inpatient bed on the oncology ward, and your oncologist comes and they spend some time talking with you, I imagine that is very precious. I can't imagine being able to do that round in any kind of speedy way.

SPEAKER_03

No, and I think you know that there's definitely efficiency and and so and all of us have um, you know, you just find your speed and your personality sort of determines how you will, you know, go about how you'll talk to people. Um but I think all of us, you know, try to maximize that that time. It's um it um that that communication uh makes it, you know, makes it much easier when there are hard times. So if there are hard discussions, hard conversations to have, then I think if you've spent time before and you have um trust, then I think that you know makes those conversations easier. Never I don't think easy, but it does definitely make make the conversation more um genuine. Yeah, yeah, yeah. I think that's a good way to describe it.

SPEAKER_02

I was going to say that all relationships are built on trust, every one, I guess, even the incidental ones you have with your barista, you know, they're all built on the fact that they're gonna trust them to make you a nice coffee. But if you are really facing your mortality and you're looking at treatment options, then the trust relationship you have with your treating doctor is absolutely paramount. And the only way to build that up is with time and genuine time. And the only way there's no shortcut around that, I guess, is what I'm trying to get at.

SPEAKER_03

No.

SPEAKER_02

No.

SPEAKER_03

No, it's pretty pretty straightforward.

SPEAKER_02

So what time of the day are we up to now?

SPEAKER_03

Oh, we're getting um we're getting close to, you know, uh clock off time. Quitten time. Quitten time. Yeah, quitten time.

SPEAKER_02

Um What time is quit in time?

SPEAKER_03

Quinn time. I know I can't lie to you, but it's usually about six. Is it?

SPEAKER_02

I can see your nose getting longer. What time is quitting what time is quitting time? About six. What time is it really?

SPEAKER_03

No, I think um uh it is generally about six. I can average that out over over over many months.

SPEAKER_02

I can average that out and I can tell all the people listening that his average quitting time on a Friday is much more like six thirty and last Friday was seven thirty. Really? Mmm. So we've gone so and you've started your first so forgetting when you got up to go for your run? You arrived at work before eight so that you could be in the meeting at eight, and now you're leaving at seven thirty. That's a long day.

SPEAKER_03

It is a long yeah, it is a long. That's why you go for a run beforehand.

SPEAKER_02

Um what time are you going for a run?

SPEAKER_03

In the in the wee hours. I think I think it's um probably the uh the hours that you know if I go out and I do you do see other people, they're usually probably surgeons and anecdotes actually. Um but um but I d I'd I would say that's not, you know, that's uh you know, just a day shared by by my colleagues, um very much, you know, by my colleagues as well. You know, I I um when we when we round at different times, you you know, we wave at each other and go, I yes. You're here, I'm here. You're here too.

SPEAKER_02

So so how how do you if you're doing that five days a week, I know that most of your multidisciplinary team meetings start at seven in the morning.

SPEAKER_01

Uh yeah.

SPEAKER_02

The morning ones start at seven, except for this lazy one on a Friday that starts at eight. Yeah. And so if you're up and ready to be at work by seven and then not coming home until seven, then that's five twelve hour days. How do you maintain that? Because now you've got five twelve hour days of seeing people who are sick and seeing family members who are unhappy. No, I mean rightfully grieving.

SPEAKER_03

Um Yeah, absolutely. Um I think the way to so it's it is hard to maintain, obviously. It's because it's there's like it doesn't matter what job you do if you have long days, and that you know, that's it's more and more frequent, I think, you know, that uh all of us are working longer days. That it's a bit there's a bit of endurance and it's not um it's definitely not completely um healthy.

SPEAKER_02

Well it doesn't sound like much of a work-life balance.

SPEAKER_03

So it makes the weekend very important. And short. Yeah, a little bit short sometimes. The yeah it makes well I think what it what it means is it makes relationships with colleagues really important. So those and when I say colleagues, I mean my doctor colleagues, but also um from nursing and allied health. I think having those good and you know, have being able to have uh a bit of a laugh and uh I think I think most of my colleagues that bring some you know humour to their work. Uh so having a good a good team, having a uh I think being able to work as part of um these multidisciplinary teams makes a massive difference. I think being um uh doing unfortunately running in the middle of the the morning. Yeah, it's 4 30, 4 30 is the best time. Very lonely. Very lonely at that time, very dark. Yeah. Uh I I yeah, I I think everybody is sort of probably trying their best to do something similar. And I know with our our kids as as they've said are big, big munchigans now, but I know my colleagues have little munchigans which require so much, you know, there's um so much time that you know that they take.

SPEAKER_02

And I Yeah, it really is.

SPEAKER_03

I think they're really amazing how they're able to do that. I you know, we're we're coming into a different sort of um stage of life, but uh, you know, doing um some of the training that they've done, the PhDs that they've done, having children, little kids, and still being, you know, great c clinicians is really amazing.

SPEAKER_01

Yeah, yeah.

SPEAKER_03

So there's different challenges and different stages of life. I feel like this is a pretty good one, this one, this stage.

SPEAKER_02

Yeah. What would you say as a takeaway to anybody thinking about getting into medicine, or perhaps the people who are in medicine or thinking about getting into oncology, would you say um run away? Or would you say, you know, go go for it?

SPEAKER_03

Yeah, well, I always um, you know, we have trainees with us, you know, um, and uh again, more and more of the trainees are just really impressive young people, and I would generally say, yeah, you know, we'll come on board.

SPEAKER_02

It's um because you're not selling it to be honest. 4 30 in the morning runs, meeting every morning at 7 a.m. Stay at work and deal with people who are dying of cancer all day and then come home at 7 30.

SPEAKER_03

I think my tip for them is No, no, I I do. I mean I I I I you know I'd say um, you know, definitely definitely come on board. I think you know, we've got some colleagues who've done dual training. I think that's been a really good way to I yeah, I know.

SPEAKER_02

I've just robbed for people who because it's a podcast so you can't see me, but I've just had a massive of like, oh why why would you do it to yourself? Dual training in what? I know, but um oncology in what?

SPEAKER_03

Uh nuclear medicine, um and I think some other bits and pieces, yeah. So but the the the good thing about medicine is that there are lots of different there's so many different parts to it and so many different parts that can suit a different, you know, different personalities. And um you have to you in in a way you sort of have to pick what's going to be um you almost have to be sort of fortunate to to make sure that you're picking the right one for you, for your for your personality job. I was very fortunate, I'd say. I had thoughts of doing other specialties, and I uh I just yeah, I just really I had great people, yeah, good, very, very good mentors. I think that made such a big difference. Um so we I think we all all of us in oncology would think of it as being a very fine thing to do that you can do, you know, can you know it's a good vocation.

SPEAKER_02

Not depressing?

SPEAKER_03

I don't think so. I see mostly the really the best in people. Yeah. In Terr you know you know in in terrible situations you see the sort of finest.

SPEAKER_02

Gosh, are you emotional? You're a cute man. This is why he's laid everybody in his waiting room. To just be patient with him.

SPEAKER_03

I'm gonna have a drink. No, not of water. Sorry.

SPEAKER_02

We can cut that out.

SPEAKER_03

You can cut that out. No, I like I see the um you know people, whether it's um the patients themselves or their families being just the the most amazing behaviour. Yeah, just yeah support, care. Love, I think. Yeah.

SPEAKER_02

Love. Yeah. Dr. David Thomas, you're a delightful guest. Will you come back on my podcast? Because I have questions about well, I want to know the difference between chemotherapy and immunotherapy and targeted therapy. And I think lots of people want to know that because I feel like m chemotherapy is a word that is sort of maybe misunderstood and is grouping a lot of different things together. And also, I think people have this idea that chemotherapy is that bright red one. Is that Doxar Rubison?

SPEAKER_03

And it's not all like that anymore. It's not codiscordial.

SPEAKER_02

Not anymore. As a pharmacist, there seems to be a new monoclonal antibody that someone has just randomly put a bunch of letters in front of and then mab at the end and then call that a drug name.

SPEAKER_03

Within our department, we have uh a big range of ages, and uh I am now in the at the geriatric end. You're getting old. I'm getting old and grey. And I um share that with uh few of my my colleagues, and we can look back at the days when there were very few things that we could do and they were really toxic. Yeah, and not very effective, but also the the really good thing that we can look at is um the way in which treatments have well new treatments have um developed and come on board and the differences they've made, and that's that's really wonderful. Being able to look over that uh expanse of of time is actually, whilst it's worrying because it is an expanse, it's also gives you um a nice perspective, mainly that things have improved. I don't think any aspect of it has gotten worse than it's deep, as my friend would say. And so, you know, the models for care are better. When I was a younger doctor, they didn't have MDTs. In fact, people were thinking, oh yeah, you know, they don't they don't actually there's no evidence to show that they have um make a benefit. You know, you don't have to get together, get together and collaborate with your colleagues. It is really crazy. So the understanding of cancer, the understanding of the body, the understanding of the immune system's all improved. The number of agents and the way in which they can make them is just astonishing. Uh the complexity is increased. It's made it harder to get your head around, but at the same time, it's all you know, it again it's positives. So, you know, when when there was just one thing that would change in in a few years, and now pretty much every year, it seems to bring uh an advance. It's just yeah, it's quite quite marvelous. I know that a lot of cancer is hard to treat and ultimately terminal, but there are still you know, still cancers that have that, and we want to see, you know, changes. Um perhaps you know, some of those cancers where it is difficult. The there's still advances, but the increments are smaller, but we're still seeing improvements. So all of that makes uh a big exciting medicine. Yeah, and my so my namesake, Dr. David David Thomas. Dr. David or Professor David Thomas, he is, I guess, organisation omaco or CASP, you know, at the forefront of what we want, which is uh genetic testing, a breakdown of of the character of the cancer and you know, just seeing whether there are personalized specific options for for um for treatment. So that's you know one aspect I can think of that's a a great change in what we do, but it's across the board.

SPEAKER_02

So will you come back on on the moans and talk to us about treatment and how it's changed and the life-saving chemicals that we're able to give people and genetic testing? We'd love to have you.

SPEAKER_03

I shall. I shall come back and I I will bring my dog. Don't bring your dog. I'll bring my dog, he's awesome.

SPEAKER_02

Um the little dog is just lying on the couch, um, just on the on the pillow being very cute.

SPEAKER_03

Yeah.

SPEAKER_02

So thanks for coming on, The Moans.

SPEAKER_03

Yeah, thanks. Thanks for I hope that was good.

SPEAKER_02

That was wonderful. That was so informative. Thank you. No worries. Bye.

SPEAKER_01

Bye for still.

SPEAKER_02

Many thanks to David for joining me in this podcast. One of the things that struck with me most from this conversation is that while we often think cancer is about scans, pathology results, and treatment protocols, what really came through was the importance of people. The nurses, pharmacists, surgeons, radiation oncologists, nuclear medicine, palliative care teams, allied health staff, and administrative teams who work together behind the scenes. The colleagues who challenge each other, support each other, and ultimately help deliver amazing patient-centered, holistic care for better outcomes. And perhaps most of all, the patients and families themselves. David spoke about the privilege of being welcomed into people's lives during some of their darkest moments, but also witnessing extraordinary resilience, generosity, and love. If you've enjoyed this episode, please subscribe and leave a review and share it with someone who might find it interesting. And if you'd like to hear more conversations that pull back the curtain on how healthcare really works, let me know what area of healthcare you'd be interested in. As always, you can find me on TikTok and Instagram at Prescribe or Pass and on YouTube on the moons. Until next time, we get on the moans. Take care of yourselves and each other. Bye bye.