Session 79 Dr. Brittany Davidson is an academic OB/GYN Oncologist practicing at Duke Health. She joined us to share the specialty she chose and why it’s great. Please help up find more guests for this podcast by sending an email to team@medicalschoolhq.net and write the subject: Specialty Stories Intern. [01:40] Interest in Oncology Brittany has always been interested in women's health even back in college. She then followed the path to medical school, realizing she loved being in the operating room as well as the people and the OB/GYNs she worked with. She saw how they were happy at work - something she wanted to be like. After her third year rotation as a medical student, she was pretty cemented to OB-Gyn and didn't realize she was going to do Oncology until 2nd-year residency. Going into OB-Gyn she was thinking it was all about delivering babies and bringing joy to the world. In fact, she remembers telling her medical school tour guide that she didn't want to do Oncology. However, after first rotation as a 2nd-resident and coming back from honeymoon and a day in the clinic, she just fell in love with patients and the operating room, taken by surprise. "There's always something and that's the fun part is figuring out what that something is sometimes." [05:18] Traits of a Good Gynecologist You have to be interested in being in an operating room but you also have to be great listener. By not talking and letting that patient have that time is very important. With the information you get from them, you can help potential treatment options. "Listening is an under-recognized, underutilized field that I'm really starting to do more of myself and trying to instill that in the people that I help train." It's hard to be quiet as silence is really awkward but that's where sometimes the best and most information comes through. As physicians, we don't learn enough about how to communicate as physicians but it's a ubiquitous skill across fields. [07:30] Types of Patients and Treatment Process As a GYN/Oncologist, they're referred to as oncologist below the belt. They take care of female reproductive cancers - ovarian, uterine, vulvar, vaginal, cervical cancer. They also take care of pre-cancer, the precursors to those cancers such as cervical dysplasia or vulvar dysplasia. They also get referrals for difficult or extensive benign GYN surgery like difficult endometriosis patients, although they still see some benign gynecology in their practice as well as female pelvic cancers. Benign OB/Gyn or general OB/Gyn practitioners these days are jack of all trades as Brittany would describe it. They do a little bit of obstetrics and a bit of gynecologic surgery. But a lot of them don't operate enough these days to feel comfortable doing some of these very difficult GYN surgeries. And a lot of times, they don't have the volume to feel comfortable trying to do these surgeries. In terms of patients coming to her already diagnosed versus those she still had to diagnose, she'd give it a ratio of 50-50. They get a lot of referrals for ovarian masses to help triage whether this is high suspicion of cancer or not. They also see cancers of the uterus. Unfortunately, with ovarian cancers, the vast majority of them are diagnosed with advanced disease. They have a lot of symptoms as well as anxieties or evidence of metastasis on imaging. In short, they see a little bit of everything. [10:27] Typical Day and Percentage of Procedures As an academic OB-Gyn oncologist, they have some research time. She starts clinic at 8 AM and sees about 30 patients, running the gamut of diagnosis. Mostly, she sees patients who are post-menopausal, though she does see some younger women too especially for uterine cancers. "It's never a dull moment because each patient is different." On a surgical day, OR starts at 7 AM. Never a dull moment as well -- she could have a whole day of cancer cases. Some days, she could have benign days. Again, it's always something different that she