6 minute read
Advocate, supporter, oncologist
Fifteen years after starting down his chosen path as a radiation oncologist, Dr. Nelson Leong reflects on the many and varied facets of his role
Fifteen years ago, Dr. Nelson Leong was introduced to the field of radiotherapy at his medical school’s sole lecture on the topic. Captured by the promise of a field that combined physics and cutting-edge technology, while still affording patient relationships with direct patient contact and continuity of care, Dr. Leong had found his calling. Since beginning his career in radiation oncology with the Saskatchewan Cancer Agency in 2013, his chosen path has shown itself to encompass even more than he first expected. The SMA spoke with Dr. Leong to hear his experience and learn about the many roles he plays as a physician who cares for those living with cancer.
Dr. Leong practises at the Allan Blair Cancer Centre in Regina. Originally from Calgary, he completed his medical school and residency in Edmonton, and did a fellowship in breast and genitourinary malignancies at the B.C. Cancer Agency.
Q: In your practice you meet people at one of the most frightening points in their life. What roles does that require you to play besides physician?
That’s a really nuanced question. It’s true that I’m privileged to be invited into a part of patients’ lives that most aren’t privy to. I do truly believe that a physician’s role extends beyond the stereotyped view solely of a provider of medical expertise and its associated paperwork.
On a daily basis, I find myself channeling any number of my colleagues and allied health-care workers. For example, I’ve often been in the position where I’ve needed to deliver bad news to a patient and their family. I’m blessed to have a fantastic multidisciplinary team including social workers, nurses and other allied workers where we can each play to our individual strengths and look to each other as resources. During these difficult times, I often find myself putting on a number of their hats – and imagining what they would do if they’re not present – to help present education, support, and planning for my patients.
Some days, I’m part social worker, like when we’re having a hard discussion about what our goals of care look like, or when we’re brainstorming how to remove barriers to care from a patient that needs to travel to a neighbouring province for therapy. There’s a lot of personal advocating and communicating, especially when trying to convince insurance companies, or workplaces, to fund a treatment or time off.
I recall one patient we had who needed to fly to another city for radiation treatment. She didn’t have any family. She had a lot of anxiety about travelling – flying in particular – and she would get overwhelmed with planning, and the stress of getting from place to place. The medical social worker and I organized a hospital admission in the other city, transportation, treatment, and all the little logistics in between. I definitely can’t take all the credit for this one though; the social worker was an enormous help, and literally walked this patient up to the gate to get her on the plane at the airport.
On other days, I’m part medical administrator. All of the physicians at the Saskatchewan Cancer Agency assist with providing input in the most patient-centric, yet still efficient, manner to provide care. Implementing new programs and all that new technology requires a separate kind of developed expertise. Since joining the SCA, I’ve found myself on a number of committees for initiatives to improve our care.
I don’t think there’s a single week where I don’t get the opportunity to check off all of the Royal College CanMEDS roles at work.
Q: When you decided to specialize in oncology, did you anticipate you’d have to wear so many different hats?
I was expecting some of the extended parts of my practice. For example, I anticipated being in the position to have the hard conversations with patients and being able to build relationships over time with patients. These were the aspects of oncology that drew me to oncology over some other, more service-based, procedural specialties. We receive a lot of support and education at the SCA from our allied health colleagues, which helps a lot with the communication piece.
At times though, it feels like there’s an overwhelming set of roles I’ve been asked to fill. I was not expecting the active involvement physicians take on as leaders and administrators. Prior to working at the SCA, I couldn’t specifically define the role of a project manager. In the last few years, I’ve had to learn how to take on that role, learn a new language, and help generate things like requests for proposals, Gantt charts, and operational milestones.
Q: What do you find most challenging in your practice?
I believe that being an empathetic, engaged, and proficient medical provider requires a degree of personal vulnerability. It is the great paradox of our craft.
It takes a lot of mental fortitude and discipline to share and support patients through their emotional highs and lows. A lot of times I feel what my patients feel, both good and bad. Feeling and emotions are good; they provide passion, purpose and connection. However, I still need to be able to provide sound medical advice. Throughout the day, a large proportion of my personal feelings have to be packed up and placed on a shelf until the day is through. Once it’s the end of the day and all the patients have gone home, those feelings are there, and they still need to be processed.
Having several other roles – like the administrator, innovator, educator, and scholar – really reduces the amount of time to decompress, and refill that emotional reserve at work.
Q: How do you cope? What do you do to take care of yourself?
I’ve really tried to start being more selective about extra roles I’m going to take on. I’m still super keen to improve patient care with new initiatives, but I try to remember that we work as a team, and consequently I don’t have to sign up for every committee.
When I need to talk, I’m fortunate to have wonderful family members who are trained listeners. I do try my best to find healthy outlets to refill my emotional reserve when I’m away from work. I’m a recent subscriber to the exercise and yoga routine. I also do my best to revisit my favorite hobbies. Prior to medicine, photography was a big part of my life. With the fatigue and stresses of work, after a long day, sometimes it feels daunting – and exhausting – to even think of picking up my camera. However, if I push through that, I remember and experience the joy that photography affords me, and I really do feel better afterwards.
Q: What do you find most satisfying about your work?
There are many intrinsic rewards to working in cancer care. Our cancer care team is second to none, and my coworkers make coming to the clinic each day a joy. Even when things look bleak, I find meaning in helping to provide patients comfort.
However, it’s not all bad! As I mentioned before, I do see patients at some of the lowest points in their lives, but the cancer care we provide is truly making a difference. If we look at all comers, we “win” more than half the time ... which is better than I can say about my favourite hockey team. That means that I get to share in a number of patients’ triumphs. This includes sharing imaging scans with no evidence of cancer, ringing that big bell at the end of radiation treatment (it’s a local tradition), or hearing stories from patients who attended life events they might not have been able to without treatment. ◆
