“A Day in the Life of a Urologist”

By Matyas Jakab

Interview Questions Laura Derbyshire, ST3 in Urology

1. What aspects of the specialty made you choose urology?
I have had an interest in Urology since doing a placement as a third year medical student. I loved the variation of working between the ward, clinic and theatre. It was the first time I had experienced a surgical specialty and loved being in theatre and watching the operations. I did my first skin incision under close supervision from the senior registrar to insert a testicular implant! Urology has fascinated me ever since. People often come to me with very personal problems, and we can make a real difference to people’s quality of life by solving them. We do many of the investigations within our department and can also manage conditions medically as well as surgically – so it is not always straight to an operation. The operations are a mixture too, with some relatively short, and some long and complex. The on call period for Urology registrars and consultants is currently 24hr due to the lesser workload compared to specialties such as General Surgery. This means that our work-life balance is better. I’m yet to meet an unhappy Urologist!

2. How early did you start to work towards a career in urology?
I had the advantage of knowing I was interested in Urology from early on, which means I had plenty of time to learn more about it and build up my CV. I did placements in related specialties whilst at medical school such as General, O+G, GUM and Renal. I kept in contact with the Urologists I had met initially and got involved in projects they had going on. I remember sitting in the office putting letters into envelopes for hours on end, but it was worth it to have my name on a published paper! I then contacted Urologists in the hospital I was working in once I qualified, and did more audit, research and teaching. I ensured I would get jobs that included Urology: initially an academic foundation post with the research in Urology, and then a themed core surgical job doing 18 months of Urology.

3. If a medical student has a particular interest in urology, what would you advise they do to nurture this?
Although it is important to decide what you want to do as early as possible, it is equally as important to be aware that your interests may change, particularly once you are in another department with different staff or working practices. To ensure it is the subject you like, go and do it in different places and imagine doing it 24/7. Work out the training pathways and think about what this means for your personal life. Are you happy to be placed in other surgical specialties that aren’t Urology? Do you want to be doing on calls at 32? But once you are happy it is what you want to do, you need to get to theatre as much as possible and build your CV. Do this gradually and do not leave it till you qualify. As a student you have so much more time to do projects and if you are in clinic or theatre and are keen, you will get given opportunities. Ask the junior doctors and registrars if they have projects they need help with, they usually have an idea brewing that just needs help to get finished.

4. Urology seems to be specialty dominated by males (both as doctors and patients), and the job involves investigations of sensitive body areas. Does being a female urologist pose any particular challenges?
Good question! I have never had a male or female patient refuse to see me because of my gender. I think it is up to us to make patients feel at ease, as it is usually a very personal issue they have come with. Some men, usually those who are older, have said to me they actually prefer to see a member of the opposite sex, presumably because admitting certain things to a woman is easier. I think as long as we are sensitive to the fact it may be issue it isn’t a problem; most patients just want the best person for the job and the stereotype of the male surgeon is now changing. Urology is one of the surgical specialties with the highest proportion of female trainees, so ironically we are at the forefront of becoming more gender equal. I certainly have never had any issues from male colleagues about me being female and have had nothing but support and encouragement. The president of the Royal College of Surgeons is now a female Orthopod so we are getting there!

5. And what would you say to female medical students considering the specialty?
I would say if a female medical student wants to do surgery then go for it! Do consider the impact on your personal life, as you won’t have the same lifestyle as a GP trainee, for instance. But if you love surgery the there is no reason you can’t do it. Urology is very female friendly and of course it is the best specialty anyway! There is increasing political awareness of females being in surgery. Less than full-time training is being sorted out by those going before you, with the support of the Association Surgeons in Training (ASiT) and the Royal Colleges (for examples the WinS group), so it should be much easier once you get there if you want to mix work and family.

6. Being a surgical specialty, how easy is it to have a family/free time when working in this field?
Surgery is not a 9-5 job, and because of the extended length of training you will do on calls until you become a consultant. So if you don’t like them, don’t do surgery! In terms of experience, on calls are one of the best times to learn, and as you become more independent you really feel you make a difference. It is entirely possible to have friends and a family alongside surgical training. Often it is the CV-building work that eats into personal time, but depending what you get involved in this can be flexible. I would suggest you need a partner with lots of patience and that you need to be able to organize yourself and be aware of balancing your time. It is a fact that to learn a trade like surgery, the number of hours you spend operating is important.

7. In terms of your own career, are you more enthusiastic about surgery, walk-in clinics, teaching or a combination of these choices and why?
What I love is learning new things and having variation. I like that within a surgical job we have lots of elements, be it ward round, clinic, investigations including flexible cystoscopy and prostate biopsies, or theatre. As if that wasn’t interesting enough there is then audit, research, teaching and leadership to get involved in! I really enjoy teaching in terms of getting people enthused about Urology and teaching people things I have learnt the hard way! I’m also involved in ASiT as I want to try and improve the training we receive, so as to ensure that surgical training in the UK is the best it can be for the sake of our patients, in a way that allows us trainees to be the best we can be, both personally and professionally.

8. Have you considered an academic career alongside your surgical one? Could you name some of the implications/consequences of such a choice?
I did an academic foundation post and did clinical research in Urology. I would have applied for the academic pathway but I wanted to remain in the North West at that time and there was no such post here. Looking back, although I enjoy audit and research I certainly get more satisfaction from doing the clinical job, so I’m glad I chose the route I did. At St Andrews University I did laboratory research for 4 months, and although I managed to complete an interesting project, I went slightly mad being stuck in one place day in, day out with endless petri dishes! I think in the future I may do a research degree, but only if I found a topic that really interested me. If I were to take time away from clinical practice I’d rather it be for a teaching/ leadership/ political role, but I think it is very hard to predict the future. I think that greatest thing about being in a medical career is that the opportunities that come along are surprising and interesting, and I remain open to them!

9. In keeping with the title of the column we are doing the interview for, could you give an outline of a standard day/week for someone working in urology?
So I’ll describe how it is as a registrar in my current hospital. The first thing to say is one week out of six you look after the ward Monday-Friday. So your usual morning sessions are cancelled and you do the ward round seeing all patients, new and old, under Urology. On some days there will be a consultant to help with this. You then do your normal activity in the afternoon. My Monday is theatre all day, so I’m in at 7.30 am to consent the patients and make sure I know all about them. Tuesday is clinic in the morning, so I’ll come in at 8 am and do my administration before starting at 9 am. From noon is the MDT, and then after this I catch up on admin again, such as checking letters I have dictated, seeing ward referrals and reading about conditions I have seen. I also have to complete my surgical logbook and fill in assessments. Wednesday is clinic in the morning, then theatre in the afternoon, Thursday is the same, but the morning clinic is the 2-week wait clinic, so we do flexible cystoscopies if needed. Thursday afternoon I do day case surgery, and there are lots of cases I can do by myself (with the consultant if needed). Friday is our X-ray meeting in the morning, so we go through imaging with the radiologist and decide on patient management plans. Then we do a big consultant ward round, and then I have theatre in the afternoon. On top of this plan, I have regional teaching every other week, so I head down to Withington for the afternoon, and 24 hour on calls where I deal with any emergencies coming into the hospital that require immediate attention. This might be a septic patient with an obstructing stone that needs a ureteric stent, or a child who needs a scrotal exploration to rule out a torsion. To make sure we don’t work an unsafe amount of hours there are a number of free sessions worked into all this to ensure I get time off. I’ve only been a registrar for a month or so, but it all seems to be working out fine!

10. What are the most common pathologies and procedures that you deal with?
So many to name! We deal with conditions of the kidney, ureters, bladder, and male genitalia. The later means that Urologists always have some good stories, although perhaps not for the dinner table depending on the company! When I first started on Urology as a student I revised all about the kidney nephrons and the types of nephritis, only to realize that this was more Renal than Urology. Patients that come in as emergencies tend to have renal colic, pyelonephritis or hematuria, but there are lots of other conditions which you should go and see on your local friendly Urology firm.

11. Which pathology or procedure do you find the most challenging?
Patients with conditions that are hard to treat are the biggest challenge as you want to make people better – it is difficult to not be able to offer a curative operation or tablet, either for benign conditions such as interstitial cystitis or chronic pain, or for cancer patients.

Thank you very much for your time. Your answers will be very useful in guiding present medical students through their career choices.