Why Hematology - Thrombosis & Hemostasis?



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. Today's post is on why Dr. Marshall chose the field of hematology - specifically Thrombosis & Hemostasis, and she shares her reasons why hematology is a great field.




I am a hematologist focusing on disorders of thrombosis (clotting) and hemostasis (bleeding). I practice at a large academic medical center, where I see patients with a variety of both congenital (inherited) and acquired bleeding and clotting disorders. I spend a good amount of my time on the inpatient consultation service and also spend time seeing patients in our outpatient coagulation clinic and in the coagulation lab, where I interpret results of complex coagulation testing. I am also the Assistant Program Director for our Hematology fellowship and am extremely involved in medical education and career development for trainees of all levels (medical students, residents, and fellows). As you can see, my job is extremely varied, and I love that it keeps me busy and engages me on so many different levels! Here are just a few reasons I love being a thrombosis/hemostasis expert:


Fast-paced decision making

As a medical student and resident, I enjoyed many aspects of the “faster-paced” specialties such as critical care and emergency medicine. Being a specialist in thrombosis and hemostasis, I get to subspecialize in a specific area of hematology (and doing so, I get to really know the current research and evidence in my field) and I also get to help make evidence-informed recommendations in emergency and critical settings. For example, I consult on patients with serious bleeding disorders who need surgery (and require specialized management of their bleeding risk during the surgical period) and, on the other end of the spectrum, patients with extremely risky clotting disorders and histories of multiple blood clots who need interruption of anticoagulation for procedures or because of bleeding. These types of consults are always high-intensity, fast-paced, and exciting. I love having the opportunity to help make some tricky decisions in difficult settings.


Decisions are patient-centered, and there is not always “one right answer”

While we always do our best as physicians to make evidence-based treatment recommendations, in my specialty there is not always a “right answer.” For example, take a patient with a history of a large blood clot without identifiable risk factors. On one hand, if the patient is older and has many medical comorbidities that put him or her at risk of another clot in the future, I would likely recommend lifelong anticoagulation. However, on the other hand, if the patient is young and loves participation in sports like football or skiing (I’ve had many such situations!), the risk of bleeding with sports-related injury may outweigh the risk of another clot and i