Career Choices

The truth about life as...

Job title: consultant in palliative medicine

What do you do in an average day?

In the words of my godson, "I look after very poorly people." All the patients I am referred have a life limiting illness, predominantly cancer, but increasingly other end stage diseases. A typical day starts at the hospice at 8 am (time to catch up on correspondence relatively uninterrupted). Today is outpatients clinic. I spend an hour with a very distressed 44 year old woman with metastatic terminal breast cancer and her husband. He wants to visit the United States for a second opinion; she wants quality of life and good palliation. They both shed tears, but leave saying that they feel much better. Physical pain is relatively easy to palliate; emotional pain and conflict are much more difficult. A Macmillan nurse and a GP phone for advice, and the senior house officer and registrar discuss inpatients while I eat my sandwich. I leave for the hospital where I work with three Macmillan nurses. We discuss new patients from the site specific multidisciplinary meetings--newly diagnosed patients often have symptoms requiring palliation. We see a patient who is clearly dying and wants to go home. His son thinks that he should stay in hospital and be actively treated. Eventually everybody agrees that he should go home and he dies two days later. 5.45pm: back to the hospice, check my emails, prepare a lecture, and speak to a colleague about a research proposal.

What do you like about your job?

• It is varied.
• I think that I can make a difference when people have been told that nothing can be done.
• I work with colleagues from all disciplines in both hospital and primary care.

What don't you like about your job?

• Patients who are referred very late.
• Lack of awareness by some colleagues of what can and should be done.

How did you get into it?

• I discovered palliative medicine on my elective.

Prospects

Career prospects are currently good and likely to remain so.

Sales pitch

If you want a career which allows direct patient contact, close collaboration with colleagues, teaching medical students and others, and an opportunity to pursue research and academic interests, palliative medicine is the career for you.

Job title: specialist registrar in otolaryngology

What do you do in an average day?

• 0800 Ward round
• 0845 See preop patients or sign letters
• 0900 Theatre list or clinic
• 1245 Lunch/x ray, pathology, or teaching meeting
• 1400 Theatre list or clinic
• 1730 If on-call--mini ward round to see new admissions then home--on-call from home.

Three things you like about your job?

• There is close personal contact with patients of all ages in clinic.
• Generally quiet on-call from home. I can still get the weekend food shopping and the gardening done.
• Close professional contact with other specialties--for example, anaesthetics, maxillofacial surgery, audiology, speech, and language therapy.

Three things you don't like about your job?

• Having to meet unreasonable public expectations due to politicians making promises they have no way of keeping.
• We still have no cure for many ailments such as Menière's disease, and some head and neck cancers.
• Other specialties regarding us as technicians--"Please come and change this tracheostomy tube."

Why did you go into it?

I was attracted by the diversity of pathology, and the fact that it is a very practical hands on specialty. I am a touchy feely person.

Prospects

Highly competitive to get into at the moment. However, once on the career circuit, good prospects for a highly satisfying working life.

Sales pitch

I would certainly recommend this job to any doctor who cherishes a life away from medicine, but enjoys the challenges and fulfilment of surgical practice. The training is long and arduous (six years as a registrar) but I manage all right in full time employment with four "obvious disabilities"--black, female, mother of two, and married to another doctor. I must however concede that my nanny is next to none.

Montio Morgan, specialist registrar in ear, nose, and throat, Sunderland

Job title: specialist registrar in renal and general medicine

What do you do in an average day?

My time is devoted to the treatment of patients with a wide range of renal disorders, including those presenting with acute renal failure, patients with chronic renal disease (often on dialysis), and those under-going renal transplantation.

Given the vast spectrum of diseases that cause renal failure, I might see patients with clinical presentations as diverse as that of a young woman on the obstetric unit with postpartum haemolytic uraemic syndrome, or the florid presentation of a patient with acute systemic vasculitis. I am on-call for general medicine once a week, being responsible for all acute medical admissions via the accident and emergency department.

Three things you like about your job?

• I find managing acute renal failure and its complications one of the most challenging areas of acute medicine.
• I am fascinated by renal physiology and pathophysiology, of which a firm understanding is essential to manage patients with renal disease successfully.
• It is rewarding to follow up patients on the long term dialysis programme through until the time that they undergo renal transplantation.

Three things you don't like about your job?

• Renal units are busy environments in which to work.
• On-call workload is of high intensity.
• Training can often be very demanding and draining on extracurricular activities.

Why did you go into it?

The diversity of renal medicine attracted me into the specialty. In particular, renal medicine encompasses all aspects of general medicine and frequently involves managing acutely ill patients.

Prospects

Renal medicine is an expanding specialty with good prospects for obtaining consultant appointments and endless opportunities for research throughout Britain.

Sales pitch

I have had a diverse and rewarding career, from both the clinical and academic perspective, and would strongly recommend renal medicine to all junior physicians.

Paul A Glynne, specialist registrar in renal and general medicine, University College London Hospitals
p.glynne@cc.a.uk



studentBMJ 2001;09:261-304 August ISSN 0966-6494