Updated: Feb 21, 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. Today's post is on why Dr. Butt chose the field of Infectious Disease and why Infectious Disease is a great field for all.
I have always been fascinated with microbiology. During medical school, I realized quickly that I want to do internal medicine. I saw dengue, malaria and parasitic infections regularly during my medical school in the Dominican Republic. During my first few months of residency, I did an infectious diseases (ID) elective, and I had the best time of my life. Every case was fascinating and so interesting to me. The very first case I saw on ID service was a consult for a patient with pneumonia, which was not getting better on antibiotics. I noticed that the patient had unusual looking lesions on her face and hand. My attending immediately recognized it as blastomycosis. I was in awe that he could recognize the rash, when everyone else was struggling with the diagnosis. Also, the same day in the clinic, that same physician was able to offer atripla (the first one pill combination for HIV) in exchange for 6 pills that the patient was taking. I still cannot forget the grateful reaction of the patient and his wife. I considered myself fortunate to witness this event in their lives. After this day, there were countless cases where patients were not doing well and an ID consult led to a diagnosis and appropriate management.
These patients dramatically improved.
My first clinic case of my ID fellowship was, per chart, a male HIV patient, but when I entered the room, I encountered a female patient. So I apologized and stepped out thinking the chart must have been misplaced. It turned out it was a MTF (male to female) transgender patient. I learned that many transgender patients couldn’t change their name to the opposite sex on legal documents. I learned to always ask them how would they like to be addressed. I have ended up having several transgender HIV patients, who are socially marginalized group, and have learned so much from these patients.
I spent a lot of time at the local STD clinic during fellowship. What you can learn in a day at these clinics, you will never learn by reading STD guidelines several times over. You see patients for a genital lesion or vaginal/urethral discharge, you do the exam, take the bodily fluid, examine it under the microscope, make the diagnosis and give appropriate directly observed therapy (DOT) to the patient, as well as advice to make sure their partners are treated as well. You do this several times over in a day – the learning curve is tremendous.
Another memorable case during fellowship: we had two post renal transplant patients who presented with multiorgan failure in ICU. Both were doing poorly on broad-spectrum antibiotics. We quickly recognized that both patients had received their respective kidney from the same donor, a child who had died from an unknown encephalopathy. The donor’s original autopsy was negative. We end up requesting his brain pathology slides to be send to CDC. Donor and recipient tissues were positive for a rare amoeba, Balamuthia which is generally a fatal disease. One of our two patients survived. I followed him in clinic for several months.
Post fellowship, I did antimicrobial stewardship for a small LTAC (long term acute care). It was immensely rewarding to decrease resistant pathogens and Clostridium difficile infections burden in that community. I also did telemedicine HIV clinic for a state prison system, which was an excellent use of resources and a great experience. Currently, I have my outreach clinic at a rural area suffering from intravenous drug- use-induced HIV and hepatitis C outbreak.
What I love about ID the most is that we can cure most infections and make sick people better. We can cure Hepatitis C! With rapid advancements, even HIV is no longer a death sentence and has actually become a chronic disease just like hypertension and diabetes. As long as HIV patients take their medications daily, they can have as long of a life as any other individual without HIV. We can also prevent HIV with one pill now.
People in ID are pretty laid back and friendly. Lifestyle is quite reasonable and lets you have a personal life. There is extraordinary diversity in disease presentation, frequent surprises and tremendous value in patient care. Besides the bread and butter (endocarditis, osteomyelitis), you will see zebras frequently on service. Just in past couple of months, I have seen histoplasmosis, blastomycosis, bartonella, CMV, HSV, coxsackie, mycobacterium chelonae, tuberculosis, mycobacterium avium complex, rocky mountain spotted fever, shigella, brucella, coxiella, nocardia, just to name a few.
ID is consistently changing. For example, currently the focus is on Ebola, Zika, TB, malaria, antibiotic resistance, measles, Hepatitis, HIV and this focus keeps shifting.
There are many paths to take after training. You can work for the NIH, CDC, WHO, your state health department etc. based on your interest. Besides the academics and private practice paths, there are other paths including infection control, antimicrobial stewardship, public health, global health, HIV, sexually transmitted infections, hepatitis, travel, ID critical care, research, transplant ID etc.
Social history is ID’s procedure. If you asked the right question, you can make the right diagnosis. For example, patients with same presentation of fever, rash and arthralgia, but ID asked if they hunt, fish, farm, garden, have contact with animals, travel, have multiple sexual partners etc., then the differential diagnosis changes. Evolving rapid diagnostics can help make the diagnosis faster. You have the opportunity to recognize epidemics and be part of the human history.
There are so many opportunities for education to prevent infections including vaccines, malaria prophylaxis, pre-op antibiotics, hand hygiene, and clean needles for intravenous drug users, safe sex practices, contact precautions, airborne precautions, respiratory isolation, and common sense.
Antibiotics can be lifesavers or cause of death. There is a global issue of antibiotic resistance for almost all pathogens – the so call ‘post-antibiotic era’ – so the world needs ID physicians to choose and prescribe antibiotics wisely. ID is commonly undervalued compared to other sub-specialties. But most people practicing ID do it due to their passion and not for the money.