8 minute read
Show of Support
from Inside News September 2023
by RANZCR
Prof Alan Rodger has made an enormous contribution to radiation oncology in both Scotland and Australia. Here, he reflects on the people who have contributed to his success, from his parents and school teachers to his clinical teachers, mentors and husband, and offers some words of wisdom to trainees.
“I wanted to be a doctor from the age of three and told my teacher on my first day at school. Mrs Loggie, a memorable teacher, assured my parents I could be a doctor but, more importantly, that it was affordable: the government would pay tuition fees. My parents’ support was unwavering.
My local high school was the best in Scotland (I now mentor would-be doctors there). On Hogmanay [the last day of the year] 1963 my unconditional acceptance from Edinburgh Medical School, my dream school, arrived. I enjoyed my time there, not least the characters who taught us. On graduation my intention was to be a surgeon.
I approached Dr Mary Douglas (who later worked in NZ as Mary Brand), the visiting radiotherapist/oncologist at my local DGH where I was a medical HO, about study jobs in radiotherapy. She directed me to Prof Bill Duncan ('WD') who made plain it was a real job, not a study one, but would give me the two days for the exam. Following that I began surgical training in Edinburgh’s professorial units. I passed the fellowship; I survived the irascible Prof Sir Michael Woodruff’s broadsides in theatre; and I loved working for Prof Sir Patrick Forrest who was developing his breast unit with the help of two Aussie senior registrars, each unlike the local equivalents.
By the time of the exam I realised surgery did not satisfy my need for longer-term patient connection and my trainer encouraged my move to 'radiotherapy', where WD was holding me a DMRT place. Cancer care was what I hoped it would be.
Cancer care was what I hoped it would be.
As radiotherapy registrar I worked for the best clinician/diagnostic radiologist and teacher in my career, (Prof) Allan Langlands AM, known as 'AOL' to us. Many Aussies will understand: for me it meant a life-long example to follow. Later, Roger Allison left for Brisbane in time for me to take his lecturer post working fully for WD in uro-oncology XRT, testicular chemotherapy and neutron therapy in the MRC trials. It was excellent experience not least because as WD said, we did his work when he was away – and when he was there! Post-FRCR saw me in the MD Anderson Hospital working under the uniquely amazing Dr Gilbert Fletcher ('GHF').
After I was appointed to what had been AOL’s “breast” job in Edinburgh, GHF rearranged my remaining schedule to allow more breast experience with the incredible Dr Eleanor Montague. GHF wanted me fully indoctrinated in US fractionation as he decried the UK overuse of “hypofractionation”. What would he say now to 15 and 10 fraction regimes based on UK trials?
He succeeded: the Edinburgh department allowed me to double the breast fractionation to daily and we saw, from audit, reduced toxicity with no increase in recurrence. Gill Kerr, the statistics lecturer whose name is on many AOL papers, analysed the study. By then APMF’s Edinburgh Breast Unit was established with a multidisciplinary team and a breast-care nurse, one of the first in UK. Working with surgeons, scientists, trials staff, support nurses, radiologists, oncologists and pharma was the model for improved patient care. WD’s departmental audit system facilitated it, an example I copied in Melbourne.
As oncology clinical director I could pull some strings, opening the Borders clinic and moving the Breast Unit to the Oncology Centre, both better for patient care. Gill and I were working with AOL on the data set he left. In 1987 he wrote saying he was organising for Bicentennial Year “the best breast cancer conference” in a place called Leura. He said I should find the money to come. Three of us did. My partner Peter and I arrived in Australia, I gave a talk at Peter Mac, we had a private tour of the Hunter Valley organised by a patient, and we liked Oz.
In 1991 The Alfred approached me about its new radiotherapy centre. Within 18 months Peter and I had sold our Georgian house and were living in Melbourne, and I was the Alfred’s Professor Director of Radiation Oncology in one of the state’s three new radiotherapy centres, the William Buckland Radiotherapy Centre (WBRC).
The opening of a new radiotherapy department was never going to be easy—or welcomed by all. New to the whole system, I struggled with the recondite mysteries of Medicare, giving up chemotherapy and being called a radiotherapist by surgeons who referred everything to 'their oncologist'. Jo Smylie, our chief RT, kept me right and soon we had one of the best teams of RTs and physicists it has been my privilege to work with.
I could not have recruited better specialists: Sid Davis was my rock and safe pair of hands, Mike Daly established Victoria’s first radiosurgery team while Jeremy Millar established Victoria’s first radio-iodine seed brachytherapy program (Australia’s first free to public patients). Kay Hatherly AM led us into the everyday use of EPI, the AM awarded for that pioneering work.
The collective noun for a bunch of professors is an absence and I was living proof. I became involved in the College, cancer councils, trials groups, BreastScreen Victoria (which I chaired for some years) led by Onella Stagoll, and the National Breast Cancer Centre (NBCC) led by Prof Sally Redman AO.
The NBCC supported Faculty fellows to produce guidelines for the use of XRT in breast cancer, which the College endorsed. The NBCC promoted, with participation of our Alfred team, demonstration projects leading to the establishment of multidisciplinary care and breast-cancer care nurses. That improved patient care, while my quality of life was improved by women leaders like Sally and Onella.
to the breast, 1981.
In 2002 I was asked to consider the new post of Medical Director, created following a crisis period, at the Beatson Oncology Centre in Glasgow, UK’s second largest cancer centre, covering 60 per cent of Scotland. In 2003 we moved to a city we did not know and to a service whose staff morale was low. The minister, hugely supportive, found extra revenue and over £100 million for the new centre and its 11 linacs—the third centre I was involved in designing. In my career there was one constant: my partner, later civil partner and now husband, Peter. I knew from my midteens I was homosexual but neither accepted nor did anything about it until I was 28 and connected with a support group in Edinburgh. Later I joined it, even organising the counselling for our transsexual clients.
Our President’s message about the College’s determination to improve the specialties’ approach to diversity and inclusivity caught my eye. And what about that inter-collegiate float at the Sydney Mardi Gras, an event we have never attended? Why now? I’d thought there were more 'out' doctors in Australia than here but apparently in Australia, as here in UK, more needs to be done to support our homosexual, bisexual and transsexual trainees and fellow members. I commend the College.
Sexuality does not determine the quality of the care we give but it may affect how we are treated. As a consultant and later 'the boss' it was easier for me. Yet, in the 1980s a colleague, my referee, without mentioning sexuality, said, “Of course, Alan, here you are accepted as you do your work so well”. What if I was someone who did not? Overall, I felt supported by the people at the Alfred and in Edinburgh: life turned out easier than I feared as a student, HO, SHO and registrar.
My advice to trainees is enjoy your mentors, work with them. If you are homosexual, transsexual, bisexual or still wondering/worrying, remember most of your colleagues will be supportive or not bothered. Ignore the minority. Do what the public pay you to do: train well, then care for and appreciate your patients as best you can with that training—it’s not all about money.
Do what the public pay you to do: train well, then care for and appreciate your patients as best you can with that training.
Medicine will be very different as your career progresses, so embrace change as it generally improves patient care. Live your life as and with whoever you wish. For most of my cancer career, I have.”
Medicine will be very different as your career progresses, so embrace change as it generally improves patient care.
