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 if continuing the sport is really important to the patient then I would make sure they understand the risks and concerns but try to come up with a plan that is best for them and allows them to live their best and most fulfilling life. I always listen to my patients and see what is important to them before making a specific recommendation, and I always tell them that there may not be a right answer, just the answer that is best for them.


I interact with physicians in a variety of other specialties

Thrombosis and hemostasis is a field that is highly specialized yet extremely broad. By that, I mean that disorders of clotting and bleeding affect patients with a wide variety of medical conditions, with a wide variety of risk factors, and in many different settings. Because of this, I get to interact with colleagues in almost every other field imaginable – whether it be a heart surgeon who has a patient bleeding on ECMO, an OB-GYN who has a pregnant patient with a new blood clot that needs anticoagulation that is safe for both the mother and the baby, or a rheumatologist that has a patient with an aggressive autoimmune condition that is also causing clotting abnormalities. I talk to physicians of all types, and often work in large teams to discuss complex cases that require input from many specialties. I love the multidisciplinary and collaborative nature of my work.


Medical education and advocacy are large and meaningful parts of my career

For as long as I can remember, I’ve been passionate about and committed to medical education. Hematology as a specialty has been particularly supportive of these interests – our national society the American Society of Hematology has developed a whole training program for hematologists interested in education (the ASH Medical Educators Institute) and I was privileged to be chosen as a member of the first ASH-MEI training class. I am involved in multiple local and national workgroups and committees dedicated to improving recruitment, retention, and mentorship of trainees interested in hematology, and I’ve conducted and published research in medical education describing the importance of mentorship on trainees career development and career choices. I am also passionate about career advancement and gender equity for women in medicine and I was able to successfully petition ASH to create a “Women in Hematology” working group which will start meeting for the first time this year; additionally, I write regularly on the importance of mentorship and sponsorship for women in medicine. I consider it a blessing to be involved in a specialty that allows me to pursue my goals in medical education and advocacy for gender equity alongside my clinical practice in thrombosis and hemostasis.


For all of these reasons, and many others, thrombosis/hemostasis has been a wonderful fit for my personality and career goals. I encourage those looking for an exciting, thought-provoking, and evidence-informed patient-centered specialty to consider this branch of hematology, and I am happy to talk more with anyone interested!


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