Feature Image Joseph Ischia

One of the main challenges that you’re confronted with when you get cancer is that you are completely unprepared.  You’re thrust into this alternate universe, where you’re confronted with new rules, and new terminology and new specialists, new perspectives and all of a sudden, you have to make decisions and you have to talk to new people and you really don’t understand their world and where they’re coming from.

Today, you’re going to hear from Joseph, a top urologist who works with cancer and Joseph is involved in an incredible amount of work, from seeing patients and performing procedures, to doing research and training the next generation of experts. Today, he’s going to give you an insider’s view into the world of urology:

Joseph Ischia Photo

  • Breaking the news on cancer
  • 2 key reasons to get a second opinion
  • Unique make-up of urology
  • Understanding your own information needs
  • How to approach appointments and follow up
  • Why you are in safe hands with a urologist
  • How to get a second opinion
  • and much, much more!


Dr Joseph Ischia Doctor Profile

Talking Urology

Episode 009: Why The Oncologist Is Your Guide Through Cancer

Full Transcript

Joe:                  Joseph, tell me what is it like being a urologist and what does your typical day look like?

Joseph:            Being a urologist is a lot of fun.  There are a lot of different specialities and we get to choose our specialty along our training, but being a urologist is fantastic because we deal with great patients and I think very interesting conditions that urologist patients have.  My average day would look like usually getting up quite early, often well need to see patients that we’ve got sitting around in various hospitals, if we’ve operated in different hospitals, then we’ve got to get to wherever we’ve got to be to at eight or eight-thirty AM, which will be an operating list or seeing a list of seeing patients.

Those are the two main things that we do, is review patients, to chat about what their management will be or their next treatment or try to sort out their problems, then we’ll have operating lists and they will go for half-days.  We tend to have half-day operating, half-day consulting, we call it.  You can do that in either public or private hospitals.  Most urologists and certainly most specialists tend to have a mix of both public and private.

Joe:                 Tell me, Joseph, why did you become a urologist and has that perspective changed over the years?

Joseph:            I don’t think anybody grows up wanting to be a urologist.  It’s a bit of an unusual speciality to choose, thinking of checking men’s prostates and looking inside bladders, it doesn’t strike you as something that a teenage boy aspires to be.  I think this is a really important point about medical specialists.  I think there are doctors that choose their specialty, but I think far more often the specialty chooses the doctor.  Different specialties have different personality types.  I always want to be an orthopaedic surgeon, so I thought this is what I’ll do, I have a sporting background, replacing knees and hips and it will all be a lot of fun.  Then I realised, I didn’t really love orthopaedics, I didn’t love looking at bone fractures and deciding if people needed hip replacements.

One of my rotations when I was a junior doctor was to do urology and I was really stuck with it.  I thought, this is a shame.  I did it and I absolutely loved it.  There were two reasons for it.  One is that I really get on well with urologists.  The people that were my bosses at the time, I clicked with their personalities and I think some specialities are very high-strung, other specialties are very laid back.  Urology is quite good, it’s sort of in the middle.  The urologist I worked with, they had a lot of outside interest, it wasn’t just about always having to look after people or thinking about that 100 percent.  If you’ve got that great perspective, you can then bring that into your patients.

When you see them, you can be more relaxed, and I like to think that we’re relatively friendly when we chat to patients most of the time.  The second issue, so, one, I liked the specialty and I liked the doctors, but the second thing is, you find that you have a knack for something.  I had a real knack for urology.  When I was an intern, my very first year, once I had finished medical school, one of the things interns have to do is put catheters in patients.  Some people can just not put a catheter in a patient to save themselves.  I had developed this reputation of being very lucky, and I still think it was luck.  I could put catheters in patients, and there is a bit of skill to it.

There are just things that you pick up really easily or there are things that you don’t.  I always picked it up.  I had a knack for it.  I liked the doctors, but another important thing is, I liked the patients.  I really liked treating men with prostate cancer.  That was what really brought me in.  We had this prostate cancer clinic in the hospital that I worked at, and these are guys, the patients this is, that are in their 60s or 70s, they’ve had good lives, they’ve got a cancer that’s not usually rapidly progressing, and they live with it a long time and they’ve very philosophical about it.

You can imagine, that’s very different to other specialties.  Say, if you’re a breast cancer surgeon, you’re dealing with usually women, quite often in their 40s, with young families.  It’s incredibly stressful.  As a patient and as a doctor.  Looking after these people, you take that stuff home.  Having men that come in and they sort of know each other in the clinic and they’re all relatively happy, that’s different.  The worst thing that I ever would do would be paediatrics.  The thought of kids being unwell just didn’t appeal to me at all.  My speciality chose me in the end.

Joe:                 Wow.  That’s fantastic insight, Joseph.  You would have definitely hated me as a patient.  I just felt like there was a lot happening with cancer, right?

Joseph:            It’s madness and that’s how it can feel.  I’d like to say that it’s very controlled behind the scenes.  For your perspective, you as a patient, you’re given a lot of information very quickly because a lot of the time with these cancers, decisions need to be made relatively quickly.  We can’t spend three months backwards and forwards until you know every little bit about, for example, let’s choose a cancer such as testicular cancer or bladder cancer, we know from the literature that’s out there, that if you wait more than three months from when you are first diagnosed with bladder cancer to having your ultimate treatment, which may be septectomy or radiation treatment or just having that tumour removed, if you wait more than three months, we know that you don’t do as well as people who get treated in less than three months.  We are racing against the clock.

Now, we’re not proud of the fact that you would walk away not understanding what we’ve been talking about.  That’s absolutely never what we’re trying to achieve.  We are trying to get you to know as much as possible.  We understand, and it’s been shown that as soon as you sit down with someone, urology has lots of areas around it, but we’re talking cancer today, if you say, “You’ve got cancer of the bladder, this is what we’re going to do.” Studies have been done on the psychology that people do not remember the first thing or the next thing you say after they’ve had cancer.  You can have a one-hour conversation with them, where you have this wonderful to and fro and they will walk out.  They’ve done studies where, right, what did you talk about today?  The patient will go, “I’ve got cancer.” “Did he mention the treatment options?” “He did, but I can’t remember them.” Urology has a very good female representation.  We need to give you information that you can digest, and we need to do it in a relatively quick time.

Which is why these support groups being very important.  We’re a big fan of them.  I think it’s very hard for a testicular cancer, because it’s a relatively rare cancer, but for prostate cancer, for example, there are lots of prostate cancer support groups around now, they’re fantastic because people can spend a lot of time talking about it with other people who are about to go through, have gone through, exactly the same thing.  That’s very useful because that reinforces to them what the doctors said, “I remember my doctor mentioned that, is that what he was talking about?” We get a lot of that from the prostate cancer support group.  I think we don’t intend to confuse you, we do try to give you all the information.

There’s a lot of written material around that we will give you, but a lot of that can be very difficult to understand.  Even now, we know that understanding – when you do medicine, just going a bit on the side, the average person uses about 5,000 words in their general spoken language every day.  That’s just the common 5,000 words.  When you learn them, you can learn nearly any language.  By the time you’ve finished medical school, you’ve learned another 5,000 very basic words.  Essentially, we’ve doubled our vocabulary that we use when talking to each other.

That can be very hard for us to pull back when we’re trying to get across to patients, who are clearly not medically trained, you’re not supposed to be, you have your own specialities and interests, that the things that we need to say, because, in fact, this treatment will help you.  We don’t always do a good job of that.

Joe:                 You make such a great point, Joe, because I remember that I was in such a complete fog during this initial diagnosis and things happened so quickly.  Within a week, I had my left testicle taken out.  You make a fantastic point about leverage and the knowledge of the people who have gone down that road before, as well as talking to specialists such as yourself.  How do you break the news about cancer, having said all of that?

Joseph:            It’s an art, not a science.  Some doctors are better at it than others.  My personal approach is to be honest and empathic.  That’s really tough to do because there are some patients who want to be eased into it, they want to be taken out to dinner, metaphorically speaking, before you hit them with the diagnosis.  Others say, why did you spend the first five minutes wasting my time if you’re now going to tell me I’ve got cancer.  They don’t say that out loud but different people have different personalities.  It’s very hard for us, as doctors, to read what sort of personality type is the patient.  I find I have the least trouble by being absolutely honest and then getting their feedback on how they feel about it.

You’ll have, for example, say we’re talking about testicular cancer, that’s a good one because that’s where you’ve come from.  You would have noticed a lump, most likely, you would have had an ultrasound and your GP would have said, “That looks like cancer, you’ve got to go see a specialist.” That’s what it would have been.  We can see you, we’re not going to sit there, it may or may not be cancer.  99 percent of the time, a lump in the testicle is going to be cancer.  We will say, and I would start with: Right, as you’ve talked with your GP, you’re well aware that you most certainly have testicular cancer.  Then you’ve got to very quickly move onto what we’re going to do next.  This is cancer that affects the testicles, it can spread outside the testicle but the vast majority of the time, it doesn’t.

We’ve got plenty of great treatment options for you.  We’re going to start by… this is how I do it… we’re going to start by removing the testicle.  Then we’re going to check to see if it’s spread.  That’s when we do the CT scan that you would have had.  You’re always saying, and this is a great cancer for treatment, you try to give them the positives, and the vast majority of people will be cured with testicular cancer.  It’s a relatively easy conversation to have.  You’ve got other cancers such as bladder cancer, where you say, “I looked inside, you’re having bleeding, and I’ve looked inside your bladder” when they wake up, you’ve got to tell them.

I did, I noticed some cancer inside your bladder.  Now, what we need to do next is work out what sort of cancer it is and how far it’s eaten its way into the wall of the bladder.  You’ve got to give people hope, that’s what I like to do.  At the end of the day, there’s no point not telling people what’s going on.  I think it’s very important.  In fact, a lot of patients that we hear about, “My doctor didn’t tell me anything.” I think that’s extraordinarily rarely the case.  I genuinely don’t think – there are no doctors to ever hold anything back from their patients.  There’s certainly a lot that’s changed in the last 50 years with regards to medicine.  We’ve gone from patriarchal medicine, where people turned up, patients turned up and the doctors said, “You will have this done.  Don’t ask any questions.  This is what we’re going to do.” That’s not the case anymore.  It really is a journey together.

We will say to patients, “Alright, this is the problem, this is what we’re going to do together.  I’m going to operate and then you’re going to do this, and we’ll do that.” I think it’s very much a joint decision-making process, where the patients are involved in every step of the way.

Joe:                 Yes, that’s fantastic, Joseph, because I think that honesty and directness really builds trust between you and your patient.

Joseph:            It can do.  You say that, but some people find it very confronting and they’ll say, “That doctor has no bed-side manner.” There are some doctors that do it well, there are some doctors that do it poorly, but even the doctors that do it well are going to have patients that will be upset, because maybe there are different personality types.  You’re not always going to get on with your patients.  That’s very true.  That raises a whole issue of, if you don’t get on well with your doctor, find another doctor.  That goes for whether it’s your GP, whether it’s your specialist or whoever you’ll see, because sometimes you’re just not going to get on well with people.  That’s just a fact of life.  It does not mean they’re not doing a good job from a medical perspective for you, but you’re just not clicking.  I think that can happen.

Joe:                 Yes.  When that happens, let’s say you’re a patient and something is not working, either emotionally, or you’re not happy with the level of information that you’ve provided, how do you look for someone else?  How do you start that conversation?  Where do you go?  What do you do?

Joseph:            It’s a good point.  There are two reasons you should go see another doctor.  One, if you’re really not getting on well with your doctor, and that’s usually personality.  The doctors, I feel like I’m closing ranks, we are very well-trained, and we need to continue to maintain standards that are at least acceptable to our peers.  It’s a lot like airline pilots.  Some airline pilots are good, some are bad, but the planes hardly ever crash, right?  Even the bad ones are still doing a really good job.  That’s like your doctor, there’s a 50 percent chance that your doctor is below average.  That’s just statistics, right?  Even if he is or she is, they’re still doing a really good job.  If you don’t get one with a doctor, go find another one.  The best place to start is your GP.  The GP is the most important person is any part of your medical treatments or medical pathways and management that you’re currently going.  Go back to your GP and you just say, be honest, “I didn’t get on well with him, is there anyone else who you would recommend?” That’s one reason.

The second reason you should go see another doctor is for a second opinion.  You can get one incredibly well with your first doctor, but we’d always recommend that you consider getting a second opinion for something that is going to be a major decision, such as a major surgery, major treatment plan.  It’s always good to hear someone else’s take on it.  Doctors don’t always agree, and you want to know that you’re making the best decision for you at that time.  Once again, your initial doctor probably will be a little bit offended but shouldn’t be, because that’s medicine, I know, I’ve certainly had patients that have gone for other second opinions and you think, “Didn’t I do a good enough job?” In fact, if I were a patient, I would go get a second opinion.

That’s exactly what I would do because you want to make sure you’ve got the most and the best information.  After a second opinion, it’s probably a law of diminishing returns, then you would see other people who have gone to see five or six specialists.  In the end, they just end up being more confused.  You GP is the right person to do that again, or you can even ask the specialists you’re seeing.  You could say something like, “This is fantastic, I understand that getting a second opinion can be a really important part of my treatment, do you mind if I do that?” Any doctor worth their salt should say, “No problems.” “Is there anybody you would recommend?” You could get a GP recommendation, or a recommendation from your specialist.

Joe:                 You make a fantastic point, Joseph.  It’s such a stressful time, half the time, you don’t know what you’re really doing, what is the procedure going to be like, what are the side-effects from chemo or radiation or another treatment.  Do you think it’s a good idea to bring someone to the appointment with you, maybe a partner or a friend?

Joseph:            Absolutely, if you can.  Yes, would strongly recommend partners come along.  If you don’t have a partner, you can get a family member or a friend to come and join you, because of the problem that we had initially.  Which is after you say, “Sorry, Joe, you’ve got cancer.” The next 20 minutes is lost on you, really.  Whereas, the friend or the partner is very good at remembering that stuff because it’s not as personal to them.  Admittedly, if it was your spouse, they might freak out as well, but they’re usually a lot better at remembering stuff because the person that it’s affecting primarily, they really do shut down after that diagnosis.  We find the spouses are very good for that reason.  Absolutely.  You’ve got to remember, it’s up to the patient.

As a doctor, my only responsibility is to the patient.  Now, if the patient says, “I don’t want my family here.” That’s fine.  If the patient says, “I would like to bring in half the football team.” I can say, “That’s going to be pretty inconvenient.” I’m happy to give it a go.  The patient shouldn’t feel, “I’m being pressured by my family to bring them along.” My only responsibility is to the patient.  That’s very important.  The importance of the patient-doctor relationship is the only thing that really matters in this whole thing.  Quite often, that will involve the patient saying, “I want you to keep my family involved.  Then that’s what we’ll do, because it’s their request.

Joe:                 Yes, that is a great point, Joseph.  If someone has questions in between their appointments or after a procedure, is it okay to ask for a way to contact you, maybe an email address?

Joseph:            Yes, email address is probably the best because as specialists, we are usually very busy.  In fact, we are usually seeing people, to answer a phone call, we’re usually having to stop what we’re doing for one patient to answer a phone call.  If that’s an emergency, that’s fine, but we don’t tend to answer our phones while we’re chatting, we’ll catch up in between patients or when we’ve got a break.  An email is the best way because we can get back in touch with that at a time that suits us and get the information to you.  The problem with the email is that you don’t want to get caught up in a long to and fro, because emails are very tough to get across information.

They’re very impersonal and they can be misinterpreted.  It’s usually better.  If it’s just a, “Did you say I should start this antibiotic this afternoon?” Yes, that’s a good answer.   If it’s, “What were the side-effects of that treatment again?” That’s not a good email because that’s something you should have face-to-face, because I can say, “One side-effect is that you might become incontinent with this treatment.” You can’t just leave that hanging there.  That’s a big thing to have there.  This gives you a risk of getting cancer.  Well, how big is that risk?  If you’re doing it face-to-face, “That risk is very small.  In fact, the study that showed that risk is probably an artefact, not real.” You’ve got to be able to put things into context, you can’t do that, or you’d be writing ten-page emails every time to make sure you’ve got every nuance across.  Simple questions, yes, difficult ones, I’d make another appointment to come back and see them.

Joe:                 That’s a great point.  I think the knowledge that you can actually make another appointment to follow-up and clear up any questions that you might have, I think that’s really important.

Joseph:            Absolutely.  We strongly encourage that.  For example, we very rarely give you all the information in one sitting and then expect you to go off and have a big operation.  Mostly, we’d say, right, for example, let’s just go to prostate cancer.  Okay, you’ve got prostate cancer, it’s the sort of cancer that probably needs treatment because not every cancer needs treatment, but yours does.  Your treatment options are surgery or radiation.  Here is an information booklet.  I’ll tell you about surgery, about radiation, here’s an information booklet, I want you to come back in two weeks and see me.

Now, if you’re interested in radiation, I would recommend you go and see a radiation doctor.  If you have decided that you think surgery is the right thing for you, then we can do that, but you don’t say to them, “You’ve got prostate cancer, I’m going to book you in for next week.” You’ve got to give people time to take in all of that information and make a decision that’s right for them.  You’ve got to remember, the decision, there are competition reasons, or there are competing facts or motives when people come and see you.  For me, my reason might be, I want you to have this treatment because it has been proven to extend your life as long as possible.

Whereas, the patient will say, “That’s fine, but I don’t want to lose my sex life which might be part of that treatment that you’ve recommended.” You can actually sometimes have a bit of a disconnect because as a doctor, we do sometimes get caught up in survival and we can forget quality of life, which can be very important to patients.  That’s very important.  That’s why there’s not always a right answer.  Living is not all about just living as long as possible.

Joe:                 You make a great point there, Joseph.  You mentioned other specialists.  When you refer someone, a patient to another specialist, maybe it’s an oncologist, how do you choose that person?  Is it a part of building up your network over the years, how does it work?

Joseph:            It is.  I think that’s one of the advantages of working at a public hospital, it’s that you really have a very good network straight off the bat.  There are two advantages of that.  One is you get to know what they’re like.  You get to know, and you have people that you get on well with.  You know that they do a good job and look after patients well, you’ll refer them to that person.  The second issue is, you’ve got to find someone that’s convenient for the patient.  If the patient had driven 45 minutes to see you because of whatever reason, they got referred to me as a urologist, but they need some chemotherapy for example.  In fact, it would be far more convenient for them to have that closer to home.

What we’ll often get is, say, patients that come from outside Melbourne or for whatever reason they think that coming to the city is the right thing to do.  There are incredibly good urologists in the country, there’s usually no reason to do that, but somethings you need to come in for.  For this stage of your treatment, you’re probably better served closer to home.  We will then get in contact or from our network, we’ll know, “That guy out in the country, he’s a great medical oncologist.  He can give you the chemotherapy.” There are two factors.  People that you know are good at what they do, and they need to be local to the patient.

Joe:                 Yes, that’s a fantastic point.  What about the general practitioners, what is your relationship like?  Do you meet them?  Do you talk to them?  How would they, for example, recommend you?

Joseph:            It’s one of the great questions, but I can’t fully answer it.  GPs have specialists that they refer to and you would like to, as a urologist, I’d love to become the specialist that certain GPs would recommend.  I do have GPs that refer to me and it’s because I’ve got the dad or one of my school friends is a GP that refers, another one, a couple who were residents when I was a resident, they know you.  They all refer to.  Then you start getting some that you don’t know how they heard about you, but often a patient will say, “I saw this guy, he was really good.” Then the GP will say, “I’ll put him on my roster and next time I might just send him something.” That’s how you build up is how GPs refer to.

It’s a little bit of a black box, but I don’t think any specialist really knows how.  We go out and do sort of GP presentations, so they at least get to know you and go, “This guy is not an idiot” that’s what you want GPs to think of you, really.  As far as the role of the GP, there’s absolutely no doubt that, and this is for any person, that the GP is the most important person in their life regarding the medical treatments.  The GP is the quarterback, they coordinate everything that’s going on.  The patient that has a heart disease, prostate cancer, and needs a hip replacement, the GP says, “Right, I’m going to get you to see this orthopaedic surgeon, I’m going to get you to see this cardiologist, and this other surgeon.” They coordinate all of that for the patient.  If the GP is not on their game and good GPs are worth their weight in gold, then they will take very good care of their patients.  I’d always vote, if you don’t get on well, if you haven’t got a GP that you click well with, then you need to find another GP.  They are the most important person in the whole medical system, really.

Joe:                 That’s a fantastic point you’re making.  What about, we touched on second opinions before, do folks come to you for second opinions, if so, how do you deal with that?

Joseph:            Well, we strongly encourage second opinions, there are different specialists who have different attitudes to second opinions.  Some of them see it as this patient has come to see me, great, I’m going to take over their care.  That’s not unreasonable.  That’s how they want to run it.  I personally don’t do that.  I’m very much a, right, you’re treating specialist has said, “This is how I would treat it.” I write a letter including the first specialists and I say, often you’ll get to the end, “Yes, that’s what my first guy said.” I’ll say, great, go back and see them.  If you’ve got any more questions, I’m happy to see you again.  I don’t try to take over people’s care.

As urologists, we’re all very reasonable and I don’t have any misconceptions that I’m any better than any of the other guys that are out there and they all do a very good job.  I’m very happy.  We have areas of specialty.  There are certain things that I can do that other guys don’t specialise in.  I did my fellowship in advanced prostate and bladder cancers.  I can do certain bladder cancer operations where it’s called neo-bladder, that other people don’t necessarily do.  Apart from that, we’re all very well-skilled, usually.  There are different types of urologists, as well.

There’s oncology urologists, there are functionals, people that have trouble with their bladders.  There’s reconstructive urologists.  They do people who need repair of their urethras or spinal chord patients, these sorts of things.  They can look after that as well.  Then there’s fertility urologists.  We fall into broad groups that we have our areas of interest, as well.  To get back to your question, the second opinion, very happy to do them, but I’m not looking to take over anybody’s care.  If they get to you and they go, “I want to continue seeing you.” That’s fine.  That’s certainly not my intention.

Joe:                 Cool.  There are obviously a lot of things changing in urology or any sub-field of urology, so how do you keep up with the latest research and how do you actually incorporate it into your daily practice?

Joseph:            There are a few ways we keep up to date.  One, we are expected to keep reading the literature.  We will read the latest journal articles.  I’ve got things that I’ve flagged, that if an article comes out in a particular topic, say prostate cancer or testicular cancer, I’ll get an email list once a week saying: These are the latest articles in your area of interest.  I’ll usually click on those.  Then that’s a great advantage of wanting to be a part of a public urology unit, is that they’ll be a group of urologists and you’ll bring your interesting cases to the meeting and say, “Has anybody got any advice?”

Someone will say, “I did that, and I had one of these a couple of years ago.  I found this useful, or look up this paper, that will help you.” “Okay, great.” Then the third way is we go to conferences.  We have to, well, you don’t have to go to conferences, but it’s certainly part of our continuing medical education.  We’ve got national conferences.  I go to at least one of those, usually two a year.  I’ll go to one or two international conferences a year.  It’s all with the purpose of, as any doctor now needs to, we’ve got what’s called: CME.  Which is our continuing medical education, where we have to do a certain number of things to get enough points to make sure that we’re staying up to date.  The college of surgeons, for me, I’m a urologist, are very particular on what I can and can’t claim.

They’re very strict on making sure that I keep my education up to date.  I think it’s good.  It’s great for the community that you can rest assured that the college of surgeons is bastion of old men that are trying to keep it at closed shop.  I don’t think so at all.  I think the age of what people see and everything that’s happened over the last ten years, saying, in fact, you are a monopoly and you’ve got to work extraordinarily hard to maintain that.  Surgeons do an enormous amount of work to make sure that it’s not a monopoly, but that all the doctors, you can be sure that they’re held to a high standard.

Joe:                 Yes, that’s fantastic, Joseph.  That’s obviously a part of learning.  Do you teach at the moment, as well?

Joseph:            I do.  I’m a researcher as well.  I look at ischemia reinfusion injury, which is what happens with transplant.  If you, say, take out a kidney, it sits with no blood going through it for a while, then we plug it into someone else.  That’s the ischemia, that means no blood supply.  Then the reinfusion is when that blood comes back into that organ.  It actually causes some damage.  We’re looking at ways of preventing that using zinc, so I’m fascinated by that myself.  I do research and I do teach.  We have medical students that are attached with our unit.  They will take them through cases in out-patients, when we’re seeing patients.  We’ll ask them, “Are you happy a medical student sits in?”

Everybody says, yes, that’s fine, and we’ll discuss different cases with them then.  We do teaching to mostly medical students.  We also have, the other teaching we do, is we have other doctors that are in the urology training program, training to be urologists, and will be in three/four years.  Some of them are almost fully through.  We are teaching them the operations.  It’s very much an apprenticeship surgery.  You have to teach the next generation how to do what you’ve done.  That’s how we’ve got to where we are over the last few hundred years of the guys older than you teaching the younger generation.

Joe:                 Would you say that this field is almost – I guess I’ve been in IT for my whole life and I’ve seen this evolution of technology changing so rapidly, do you see this evolution happening around urology, around oncology, these sort of areas?

Joseph:            Absolutely.  It’s almost unfathomable where medicine will be in ten years.  If you look back ten years ago and said, “You’ll be carrying around a little phone in your pocket that’s got the computing power to be able to surf the net and answer any medical problem you’ve got and probably make diagnosis very well.” You would have thought it was crazy.  That’s where we’ve come in ten years.  Can you imagine in ten years’ time what we’ll know about genetics of the disease will come on a lot?  The way of managing the disease.  I think these automated diagnosis, programs, are useful but not the be all and end all because this was one of the bit points, everyone thinks, “I can just plug my symptoms into Google and I’ll get an answer.”

You’ve got to know what to type in.  That’s what medicine will be about.  I think medicine will be about guiding people through.  Look, I’ve got a cough, I think I’m dying of lung cancer.  No, you’ve actually got this, and I think this makes more sense.  You can get lost if you don’t understand the basics of what you’re trying to get into.  That’s where your GP and your specialists are really there to help.  I think we’re a long way off automating – good for me at least – I think we’re a long way off automating surgeries.  With automation coming, there will be parts of things in medicine that will be automated that are currently done by doctors.

The classic examples would be stuff like radiology, like reading an x-ray.  Computers can do that very well now.  When the miss it, they really miss it big.  That’s why you still need urologists.  It’s a lot like planes could probably take off and land themselves, but if they don’t, you want a pilot.

Joe:                 That’s a great point.  Thank you so much, Joseph.  I really appreciate your time.

Joseph:            No trouble at all, Joe.  It was lovely to meet you and good luck with your podcast.