Physician Observation Essay

Physician Observation Essay

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My on-site experience with Dr. Ramono was surprisingly brief, less than an hour and a half long, but in this short time, I was able to observe and absorb a great deal of information. This experience took place on the B1 level of the University Hospital in the Cancer Center. Even though I was unable to shadow Dr. Ramono, an oncology surgeon, during his rounds, I was able to sit in on a multidisciplinary clinic that consisted of a diverse gathering of doctors, nurses, and social workers. After this meeting, which lasted approximately 50 minutes, he took my colleague and I into a free room in the Cancer Center to inform us of what was actually happening in the clinic and answer any of our questions.

I briefly met Dr. Ramono before he led us into a small conference room crowded with people all of which were intently listening to the central speaker sitting at a table in the middle of everything. I later found out that this was a meeting referred to as a multidisciplinary clinic that consists of specialists from a variety of areas. Because this clinic was discussing oncology patients, the people there were all somehow related to this field of study. There were radiologists, radiology oncologists, oncologists, oncology surgeons, general surgeons, psychologists, nurses and social workers to name a few. The whole reason for this variation in the people was because it is an attempt by the health care system to make diagnosis more efficient for everyone involved, especially the patient. Without these multidisciplinary clinics, a person newly diagnosed moves through a step-work system in the health fields. For example, a person normally visits his or her primary-care doctor first. If a disease is possibly developing, the primary-care doctor refers him or her to a more specialized physician in the field of the suspected disease. Then, this doctor may refer the person to another doctor. Each of these steps takes time, and often this period can be a hindrance to patients and doctors. What the multidisciplinary clinic does is eliminate this waiting period and bring all of the people involved in the care to a single platform. Here, they can collectively decide the most efficient and proper treatment for the individual being reviewed.

Besides conversing about the status of each patient during the multidisciplinary clinic, the doctors were able to actually view their biopsy through a projection on a screen from a microscope.

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This gave each person who hadn’t seen it before, the opportunity to do so and comment on it. One doctor, who had treated a patient, hadn’t seen a specific slide being shown, and because he now viewed it, certain things were brought to his attention. Since he acquired this new information about the patient, it seemed it improved his projection of her treatment. All of the slides I viewed were of female breast cancers and so many of the slides showed abnormal mammography lesions. The central doctor was able to even ask the group what they all thought he should do in a certain circumstance because he was quite unsure of himself. His colleagues were able to offer advice on whether he should perform a lumpectomy and if radiation would be a necessary treatment.

It was also interesting to see how many factors went into the decisions on what treatment was best for the person. The doctors had to incorporate how each individual’s cancer is unique to that person and then also look at how each person has a different physical, psychological and economical status. Questions often arose about what treatment is needed that is economical for the hospital and the patient, what are the risks involved in a certain treatment to the patient’s condition, how does the patient feel about these treatments, and what is the person’s insurance situation. A lot of it reminded me of a gathering of war officers briefing each other about the enemy and then planning their next attack. In addition, it appeared like this collaboration benefited both the patients and doctors because it encourages more efficient ways in which to treat patients by still maintaining a high, if not better, quality of health care.

From the clinic, Dr. Ramono led us into a small room where he told me a little bit about what he does as an oncology surgeon. First, he mentioned that after the four years of his undergraduate studies at the University of Dayton, he attended medical school in New Jersey. He then did his residency here at the University of Michigan. It is very common for any doctor seeking a specialization to undergo 5-7 more years after medical school studying this specific health field and many of these people join a fellowship that corresponds with their area of study. These fellowships often require at least a small amount of research as well. As an oncology surgeon, Dr. Ramono explained that he deals with patients directly in the operating rooms and during his rounds. However, much of his time is spent examining literature and acquiring the knowledge to treat the specific disease as well as attending meetings such as the multidisciplinary clinic to converse with other physicians. Even though it may seem that his work only benefits the people with cancer that he performs surgery on, the effort that he makes, benefits every person because more knowledge about cancer is attained with every new case.

One interesting fact that Dr. Ramono mentioned is the importance and usefulness of technology in oncology and all of the health system. He explained to us that the tools he uses for surgery have become more refined, which makes the procedures easier and safer. Besides the tools, an oncology surgeon may also use robotics during surgery. These animatronics are so advanced that with the sound of his voice, it will move to the place on the body of the patient receiving the surgery that he designates. They are only used in hospitals that will make them cost efficient though, so every hospital does no use them.

Dr. Ramono, along with nearly every other physician, seems to have attained a variety of skills during his years as a doctor. He has had to learn how to use various technologies and has had to keep up with the evolving techniques as well. His surgery techniques that he learned out of medical school and residency have had to progress with the maturity of health care. In addition, his efforts in helping the sick are aided by many various groups of people. Other doctors from different fields gather knowledge for him so that he is capable of performing a successful surgery. For example, a radiologist helps to decipher where a tumor may be located in the body and then Dr. Ramono, with this new information, can remove it. Also, administrators of the hospitals decide, in large part, what technologies will be available for the use of the doctors, which then decides what treatments a doctor can offer. Dr. Ramono also mentioned that the field of oncology is also dependent upon the National Institute of Health for developing new ideas and treatments and providing funds for certain practices.

My encounter with Dr. Ramono and the brief introduction to oncology sparked an interest in this type of health care for me that wasn’t there before this experience. I enjoyed seeing how the doctors worked together to develop a treatment plan for their patients. It was made clear to me that a doctor doesn’t know everything even after he or she receives the title “doctor”, which actually makes me more excited about the possibilities in the future. Becoming a doctor would mean that I could continuously progress and obtain knowledge instead of possibly finding a job that may pay more but it also may not be as stimulating. By being an oncologist, it would allow me to work in an environment with advancing technologies, which I find very interesting, and also, I can work directly with people. One thing that I noticed in the slides was the minute size of some of the cancers and I wondered how the surgeons could remove it. In another vein, oncology interests me because it is the study of cancer and scientists have yet to uncover the entire mystery of this disease. This presents itself to me as a challenge to somehow help the many people who get cancer, adults, children, rich and poor, and improve their overall health.
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