Updated: Sep 20, 2019
Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Want to know more about endocrine?
Some memories stick with you for a lifetime, and despite the years, the feelings come rushing back when you relive them again in your mind. I will never forget the disappointment I felt at the age of four as I sat in my grandmother’s living room after she handed me my birthday present. I greedily tore off the wrapping paper, excited to see what my new toy would be, only to see a Little Mermaid puzzle that I already owned. I yearned for something new and challenging, and now I was just handed a gift that I had already mastered. My mom politely reminded me to say thank you as I dumped the pieces out and began working on finding a new way to put it together.
Twenty-eight years later and I still love brain teasers – from the crossword puzzles I would help my grandparents conquer on vacation, to perfecting the daily Sudoku challenges in my college newspaper. As I made the decision to go to medical school, I knew that whatever specialty I would pursue needed to fulfill my love for logic, riddles, and problem solving.
As I jumped into residency, I knew there was another challenge to overcome – to specialize or not to specialize. While I tried to keep an open mind with each rotation, a few key concepts were repetitiously returning. The best part of my Women’s Health rotation was working up a patient with hirsutism and amenorrhea. During my surgery rotation, I was more interested in evaluating and working up a pancreatic mass in a hypoglycemic patient than I was discussing the surgical options. I was fascinated by the thyroid dysfunction that induced new-onset atrial fibrillation on Cardiology. It seemed that every month I managed to find the metabolic and hormonal aspects of each rotation more appealing than the actual specialty’s focus. And yet, there was still the thought of whether Endocrinology aligned with my career goals. Being the lead that coordinated patients, nursing staff, and colleagues from a primary medicine perspective still appealed to me.
That all changed with one simple question at the end of my first Endocrinology rotation. While evaluating several DXA scans revealing worsening bone mineral density following treatment for osteoporosis, my preceptor asked if I thought the change was significant. I confidently said yes while looking at the declining T-score. She politely smiled and said you can’t use the T-Score. “What do you mean I can’t use the T-score?” I was flabbergasted. I started to doubt everything I had learned but was even more bewildered that my own primary care attendings were equally misinformed. She spent the next 10 minutes explaining the simple concept of least significant change, and simultaneously confirmed what my gut was trying to tell me- I was destined for Endocrinology.
We spent the afternoon reviewing other cases of BMD and DXA results, and the common lack of proper interpretation. As I was analyzing these images, I realized I was putting together one giant puzzle. Looking for interference on the images, determining if LSC was calculated, reassessing old scans – all are required to put together the bigger picture and determine the clinical significance of the results. I left clinic that day re-invigorated after months of searching for my passion.
As I made my way through fellowship, and now as an attending, every day has been filled with a new challenge and trying to find the missing piece. Congenital Adrenal Hyperplasia patient with hirsutism and hypertension – which enzyme is genetically altered in the steroid pathway? Post-Op pituitary management – does the patient have diabetes insipidus or only increased thirst due to a dry mouth while the nasal packing is in place? Continuous glucose monitor report in a type 1 diabetic – how often are glucose levels in target, and where is the pattern of low sugars? And just as I used to put pieces of a puzzle together as a toddler, with pure joy in finishing it, I now spend my days solving different types of brainteasers with the excitement in knowing my patients will feel better once appropriately diagnosed and treated.
And despite most people’s thoughts about the specialty, the Endocrine world today is so much more than just diabetes and only seeing patients in a clinic. For those who like radiology, I perform my own thyroid ultrasounds and personally review all of my pituitary and adrenal imaging as well. If you’re inclined to procedures – there’s FNA thyroid biopsies, and now a new implantable continuous glucose monitor that you can place. I also spend part of my time rounding in the hospital and seeing high acuity patients – thyroid storm, adrenal crisis, liver/kidney/pancreas transplants on various forms of nutrition and high-dose steroids, neuroendocrine tumors, pituitary apoplexy…the list goes on.
Top 4 Reasons You Should Consider a Career in Endocrinology
If riddles, brain teasers, and puzzles excite you- endocrinology might be the right speciality for you
Despite what most others think, you still have the opportunity to complete procedures.
ZEBRAS. A lot of times when I hear medical students and residents talk about how they want to see the rare entities, Pheochromocytomas and Acromegaly are at the top of the list. Welcome to Endocrine my friends.
Work-Life Balance. While there are a handful of cases considered “endocrine emergencies”, most of my day, and call for that matter, is focused around a clinic schedule with outpatient issues other than when I’m rounding in the hospital.
I’ve been at my highest of highs seeing firsthand the beauty of metabolic pathways. I am energized at the possibilities that a career in Endocrinology has to offer, as well as the countless opportunities for future contributions to the field. Not only can I change the lives of my patients, but also the practice of medicine through training and education of other physicians as well.