blog posted 18 February, 2021

Blog: A day in the life of… a Breast Clinician

Blog: A day in the life of… a Breast Clinician

Hello. My name is Di Dalgliesh and I am a Breast Clinician. I undertook my medical degree at the University of Cape Town, and after working as a medical officer in Paris for 18 months I moved to the UK and completed my GP training (1997). Whilst working as a GP I undertook sessional work in the local outpatient breast clinic.

An opportunity arose for me to expand my role in breast diagnostics. I contacted the Association of Breast Clinicians whose members reported high levels of job satisfaction with a good work-life balance, particularly attractive to me then as a mother of two young children.

I left general practice in 2001 and trained as a breast clinician over the course of three years. This included a PG Cert in breast disease management, attendance at national and European breast courses and carefully logged work-based training.

As my children grew up, I gradually increased my hours and now work full time in symptomatic and breast screening clinics in Bath and Bristol respectively. I do not have out-of-hours duties.

Each day of the week is different to the others, a Wednesday being the most varied.

This starts with the Breast Multidisciplinary Team (MDT) Meeting. Imaging findings of the pre- and post-op patients are presented with radiological advice offered to the team. As a trained breast MRI reader, I am able to discuss these too. However, cross-sectional imaging is left to the expertise of the radiologists. As clinical lead of our family history breast clinic, I offer opinions about familial breast cancer issues when they arise during the meeting.

Following the MDT, wire guided procedures are performed to localise non-palpable lesions due for surgical excision. These may be ultrasound or Xray guided. The breast imaging team then meets for arbitration – we resolve first and second mammogram reader discordance, review difficult cases and discuss complex clinical issues or referrals.

In the afternoon my patient list includes clinical examination, interpretation of the mammogram, an ultrasound scan +/- a biopsy. If there are features typical of malignancy, communication skills are tested with the breaking of bad news, made more difficult by the absence of a definitive histology result.

Thus ends the busiest day of the week, sometimes stretching beyond the usual 5pm clocking off time. Although we can never predict what clinical problems will be coming through the door, this makes for a more stimulating job!

On Thursdays I undertake my screening work at Avon Breast Screening in Bristol which includes a session of assessments and another of mammogram reading.

Clinical responsibilities aside, other roles include leadership of the family history breast service and research – I was principal local investigator for two national studies. I participate in audit and quality improvement projects. A particular interest of mine is teaching, including six- monthly breast imaging seminars for third year medical students. I am educational and clinical supervisor to a breast clinician trainee in a national pilot project. I have recently started my second term as Vice-President of the Association of Breast Clinicians, and I am a member of the project board for the aforementioned national pilot.

A breast clinician is an expert in imaging interpretation, interventional procedures and resolving complex diagnostic issues. However, the close daily interactions with patients and members of the dedicated breast team is the real draw for me.

There is a national shortage of breast imaging specialists, adding an extra burden to the busy work schedule in order to meet cancer targets. This shortage is being addressed and I am confident that any doctor who chooses to pursue a career as a breast clinician will find the team-based work both interesting and rewarding, whilst leaving time to pursue other interests during rest time.