Why does oncology break SHOs
Oncology SpR in large tertiary centre. I have been working there for approximately two years.
Every rotation we have multiple SHOs going off sick with burnout/ find them crying in cupboards. This rotation seems particularly difficult with lots of long term sickness and tears.
From a senior point of view, the workload does not seem exceptionally high. they are usually asked to manage 6-10 patients each (10 would be unusual) and I think there is quite robust senior support (2 cons ward rounds per week and on average 2 SpR rounds per week). if someone gets sick I will see them on the day, sometimes within minutes of being bleeped. I try and teach on my rounds and do portfolio bits and I think most of my SpR colleagues are equally helpful. Yet they are falling like flies. We had a few difficult deaths and I am aware that inpatient oncology is a pretty miserable sample of oncology life, but nothing particularly challenging recently.
When asked how things are I usually don‘t get anything particularly useful, but then they will rip into us in the placement survey.
If anyone has done/is doing oncology as an SHO, what’s so bad about it and what would you change?
Edit
Interesting stuff. I think some points are spot on I Can understand the frustration as the SpRs often share it:
we do have a firm system and whilst the consultant and SpR are fixed, the SHOs move between firms often which is probably quite unsettling. This is due to how variable our numbers are (1 weeks breast cancer have 2 patients and the following week 12) so it is difficult to justify assigning an SHO to one or more subtypes for the whole week. We also have ACPs which Are assigned to a given firm. they do some follow up clinics in their tumour types and have been around for donkey. Quite experienced in their niche, quite junior outside of it so if at all possible we keep them on their turf.
Emotional burden is high and maybe we are so used to it that we underestimate how sad it can be to start a syringe driver in someone your age
Non-oncology issues are left to juniors to sort. This is probably true, my gen med knowledge is not as sharp as when I was an IMT and I am sure I send more referrals than medical SpR doing regular medical on calls would. consultants are obviously even worse at this and rely heavily on the SpR.
Escalation plans are a bug-bear of mine. Some consultants just don‘t do them. when they do them, sometimes it’s worse as they make an explicit plan to escalate people who should never be escalated. I make an escalation plan for every patient I admit on call.
Af the same time, I would be involved in any discussions with ITU/HDU and I hardly ever refer to them.
I think the best suggestion so far is to have an SHO rep feeding back to the SpRs. at the moment it’s all through consultants via the end of placement survey and the feedback we get it’s all a bit garbled and non specific.