It is, from time to time and over the course of this correspondence, worth reminding oneself of the underlying rationale for such a website as www.coalfacecaring.com . This is, as has been made clear from the time of its very first posting, to inform, to support and to encourage those affected by and working their way through a cancer or other life threatening illness, either as patient or carer, voluntary or professional. On a number of occasions to date throughout these postings, reference has been made to the likelihood that as with most serious illnesses (including cancer), a visit to the GP will most likely be followed by referral to an appropriate hospital specialist. In all probability, this will be a consultant surgeon/physician, although not necessarily so. Whether or not surgery (or a procedure involving a surgeon) is indicated, it is likely in almost all instances nowadays where cancer is diagnosed, that referral will also be made to a consultant oncologist. In my experience of patients and their carers, anxiety and stressful feelings are almost as (and not infrequently more) likely to be caused by “not knowing” than by “being aware”; especially in terms of what to expect upon referral to an Oncology Department. Of course, every such department is likely to function on the basis of certain idiosyncrasies. However, in more general terms, what is true about one is likely, to be reflected at least, in all.
In Glasgow, (the city in which I worked in a research/clinical capacity for thirty five years and more) the population of this vast catchment area has, for the past twenty five of them, been fortunate enough to have access to a ‘state of the art’ specialist Cancer Centre known, until recently, as the Beatson Oncology Centre (BOC) and now, the Beatson and West of Scotland Oncology Centre (BWSOC)·. Increasingly nowadays, dedicated oncology treatment centres are becoming a reassuring presence in many, if not most, major cities throughout the United Kingdom. And so bearing all of this in mind, let me tell you something about my own experience working in Glasgow and the surrounding Strathclyde Region. Hopefully, this will provide you with some idea of how such a centre or department in your area might operate from the patient’s perspective and will also perhaps provide a useful ‘picture’ of what you may expect to find there.
The BWSOC, in the centre of Glasgow, functions in the closest of cooperative approaches, with all other medical and surgical departments throughout the city and wider area, known as the Region of Strathclyde. In addition to clinics held daily within the Centre itself, BOWSC consultants are in regular attendance at ‘satelite’ and other major hospitals throughout the region. Where the specialist consultant seen in the first instance is other than an oncologist (e.g. surgeon, consultant dermatologist etc.), he/she will most likely also seek the opinion and in most instances refer the patient on to a colleague consultant oncologist, who may well in fact already be a co-member of their treatment team.
The Oncology Centre in my day possessed,and very probably still possesses, the conventional and fairly familiar medical structure and hierarchy of consultants, senior registrars, registrars, as well as of junior doctors, such as house officers and senior house officers (SHOs.). In many instances the senior registrar or registrar would actually plan any chemotherapy being prescribed. However, this would invariably happen under the watchful eye and overall supervision of a consultant in oncology. (incidentally, those consultants whose specialism is specific to the administration of anti-cancer drugs are, or were in my day, known as “Consultant Medical Oncologists”, whereas consultant-grade physicians who specialise in the delivery of radiotherapy and chemotherapy were/are known as “Consultants in Radiotherapy and Oncology”).
Sometimes confusion and misunderstanding occurs over the use of terms like, Radiologist and Radiographer. In essence, a radiologist is a specialist radiotherapy medical doctor and radiographers, non-medical, highly qualified individuals in their chosen discipline with responsibility for setting up the machines and ensuring that the correct dose of radiotherapy is delivered. In future blogs we shall be giving consideration to the means of acknowledging and addressing the important psychological, emotional and social implications of chemotherapy and radiotherapy.
We are, of course, all too painfully aware of the fact that in the very recent past, hospitals and hospital staff have been the recipients of the kind of press and publicity that none of us want to see. Wherever such deficiencies and lack of adequately supervised and sensitively delivered care is in evidence, no stone must be left unturned to root it out at its origins. Only the very best in daily practice will suffice and should be tolerated. How well I remember a filmed interview with the late and great Albert Schweitzer (1875 – 1965) the holder at an early age of doctorates in medicine, music, theology and philosophy. With the world at his feet, Schweitzer devoted his life service to medical missionary work in the African Bush; in fact at Lamborene, where the hospital that he helped physically to build, still stands as testimony to his selfless and skilful labouring in the interest of the poor, the deprived and the sick. Speaking of his great mastery over the pipe organ, Schweitzer declared. “If I miss one day’s practice, I notice the difference in my standard of performance. If I miss two days practice, those who are close to me and know of my playing, begin to notice the change. And if I miss several days practice, everyone, everywhere who knows anything at all about organ playing notices an overall drop in the standard of my performance”. Then, following a short pause he added, “So in life and in the practice of care and compassion.”