“To save patients’ lives!?”

3 months in radiotherapy and I still have my patient empathy. Perhaps a little too much.

We had lectures last week and as part of one on radiation safety, the Radiation Protection Advisor asked, “Why do we do what we do?”. Now I’ve worked with him previously and he’s lovely and so without any hesitation I shout out “To save patients’ lives!?”….

RPA: Bullshit!

Me: **quieter voice** To do cool science?!

RPA:  No, think more about why firemen go into burning buildings?

Me: **even smaller voice** To earn money?

RPA: Exactly.

This then led onto a discussion about how the acceptable level of risk of dying at work is 1/1000 a year. This corresponds to a radiation dose limit of 20 mSv. Obviously we aim to not get anywhere near this dose limit but this is where it comes from. After the lecture I even got asked by a fellow student (one who didn’t know me!) whether the lecturer and I had rehearsed that call and response!

On the plus side, it’s good that I still consider my job to be patient centred, this is what we want from everyone working in a hospital!

On the less positive side, I did get a little overwhelmed in treatment planning this week. The short-term placement trainee was working on a breast plan for a lady aged under 45. I was still working on training plans at this point but the thought of being responsible for an actual patient’s treatment made me feel sick to my core, especially one with so many years of life still ahead of them where treatment side effects and tumour control probability are even more important.

There is no solution to this. Everything I do will be checked to ensure that it is the appropriate standard before I am allowed to create clinical plans. My clinical plans will then be peer reviewed as well as checked before they head anywhere near a patient. And yet for some reason there is still a part of me that is absolutely terrified. Quite a large part in fact.

My supervisor remarked that making changes to machine outputs can have far greater effects on far greater numbers of patients and I can do that without crippling anxiety. But I think the difference lies in the absolute nature of an expected output vs the continuum of clinically acceptable plans. A dosimetrist tried to reassure me by saying plans can always be improved but there comes a point when it is better to stop and move on because you can’t spend an infinite amount of time on each plan you produce. One suggested endpoint is whether you would allow a member of your family to be treated using the plan.

I am sure this will be an ongoing struggle for me. But as my supervisor also pointed out, it’s much better for me to be crippled with anxiety about screwing up than be completely blasé about the whole process. Experienced planners like the fact that the patient record has a photograph attached because it reminds them that the plan represents a real person. I should probably try not to look at the photographs for the time being.