Biggest mistakes starting practice....

[dieABRdie]

Now a year out in practice I've reflected on a couple missteps I've unintentionally made starting out. I thought it might be useful to collect some of other people's thoughts to avoid any further unpleasantries.

My #1: Not realizing that other physicians don't look at the images. I find mistakes all the time that change the game. A few times I've relayed to the patient before the referring physician. Turns out they don't like that.

---

Members don't see this ad.

 

[RADONC4285]

Now a year out in practice I've reflected on a couple missteps I've unintentionally made starting out. I thought it might be useful to collect some of other people's thoughts to avoid any further unpleasantries.

My #1: Not realizing that other physicians don't look at the images. I find mistakes all the time that change the game. A few times I've relayed to the patient before the referring physician. Turns out they don't like that.

100% true. Med oncs almost never look at images and frequently miss nodes or think the patient is a candidate for definitive treatment when they're not. Even surgeons don't look at imaging carefully. Definitely makes for an awkward conversation with the patient. But this really emphasizes the importance that we continue to look at images and not rely on reports

 

[jondunn]

doing this in the right way and speaking up at tumor board when they scroll through images and say 'hey there's a node there, scroll back' is really important IMO

understanding the whole picture including keeping reaosonably up to date with systemic therapy as well as being the ones to really understand the imaging are how we can continue to show our value in each of our own small pods, to our community of care takers.

 

[fiji128]

Not appreciating how important the referral patterns are for your practice. Its much better to be in a situation where you can get some direct referrals versus everything passing through medical oncology.

 

[TheWallnerus]

If you're in a group with a few rad oncs or more, be the rad onc that gets their contours done quicker than anyone else. The moment you get notified, just go ahead and do 'em. You'll become very loved in the dosimetry silo.

Dictate and get all notes done ASAP too. Make the notes not too long-winded. Get right to the point. As a corollary to @dieABRdie that no one looks at the images, no one is going to read your 6 paragraphs discussing the subtle nuances of elective nodal irradiation in various stage II breast presentations. (I blow my long-windedness wad on SDN... thanks SDN!)

Every chance you get with the patient, speak very highly of the referring physician.

 

[Mandelin Rain]

Say "no" to some things. You're allowed to. Especially when approached by administration.

 

[BobbyHeenan]

Say "no" to some things. You're allowed to. Especially when approached by administration.

Agree.

Use of time is better spent going to as many tumor boards as possible...not on tasks admin is trying to offload on you.

 

[Mandelin Rain]

Agree.

Use of time is better spent going to as many tumor boards as possible...not on tasks admin is trying to offload on you.

They always target the young, agreeable doc. If you say yes too much, they'll never stop.

 

[thecarbonionangle]

1) Be nice to people from the janitor to your colleagues. Be the guy/gal people come to for help and want to grab a beer with after work.
2) tied to above. Do not be an arsehole
3) get your notes in and contours done ASAP. People make their opinions about you quick from admin bean counters to billing to your colleagues. You want to be seen as efficient and able
4) answer the phone, text people back within a reasonable time, be available, affable
5) be a good coworker and do not dump your work on others, sign your plans and prescriptions on time
6) keep your hands to yourself and do not sleep with people you work with
7) never say something bad about a referring to a patient thinking you buddy up. They are not your buddies. Dr X who sends me patients is a fantastic physician and a friend, always!

sadly seen people make these mistakes over the years!

 

[communitydoc13]

They are not your buddies. Dr X who sends me patients is a fantastic physician and a friend, always!

Admittedly one of the hardest things in practice over the years and one of the reasons why physicians are so bad at culling the bad apples. This is not hard for 95+ percent of your referring physicians probably anywhere. All of whom meet my minimum standards anyway. However, there will be some very bad and established doctors (usually talking about surgeons for us) out there and unless you and they are both part of a larger hospital system, your refusal to work with them will not lead to meaningful change and you will have no leverage over their career.

What to do in those situations where you believe a referral out and away from the referring doc is absolutely in the patient's best interest can be agonizing.

 

[ramsesthenice]

Lay low for a bit and learn the local practice patterns. Too many young people come in like a bull in a china shop trying to recreate where they trained. If you haven't had the pleasure of working with that new grad who constantly says "well at Harvard..."

 

[Reaganite]

Some GREAT advice here! I thought I was the only one who had read the playbook lol. I always stress to new associates not to waste endless amounts of time writing detailed notes on standard cases where everybody knows what you have to do. Nobody cares about the whole breast trials or dose escalation in prostate CA. Agree with spending your time on practical stuff like planning and getting patients in as quickly after sim as possible. Patients and referring docs love that. And yeah, review your own imaging. My god, review it all. I'd get burned several times a month if I didn't read my own imaging.

 

[evilbooyaa]

Really good thread. I don't have a whole lot to add (as someone also recently out in practice) on top of most if not all of the comments left above.