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Why Endocrinology: Patients Are a Virtue

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My decision to pursue endocrinology stems from the patients that I have met throughout my lifetime and the stories that they share. My inspiration also comes from mentors throughout my medical training who have shaped me into the person that I am today.

During medical school, I chose to volunteer in a remote village in India where diabetes was highly prevalent. Knowing that I would be helping with diabetes care, I remember spending nights before that trip reading about diabetes, familiarizing myself with diabetic drugs and all their mechanisms of action. I even made flash cards with the different types of insulin and their varying pharmacokinetic profiles. I felt so ready and prepared to battle diabetes with NPH, 70/30, or whatever was needed!

When I arrived in India, I quickly learned that my flashcards were not necessary. The needs of these villagers were complex, and I soon realized that insulin wasn’t all that they needed. I met Narain, a type 1 diabetic who was blind in one eye, and on the verge of dialysis by age 37. He was diagnosed with type 1 diabetes at age 35 which was the same age he saw a doctor for the first time! He did not understand his hyperglycemic symptoms for years, and thought it was a “natural part of aging.” Narain was engaged to be married, but as soon as the diagnosis was made the wedding was called off. Diabetes affected his health, his life, and his future. I remember thinking how life was so unfair to him, and if he had been in the U.S., how things might have been different.

This village had no access to doctors, no access to medications, and even when there was access to medications – there was no refrigerator to store it in properly. Many of the people I met had no education on what diabetes was, and/or how to prevent it. I was surprised to see older individuals with years of vision problems undiagnosed with diabetes. I spent hours educating them on diabetes, its symptoms, treatment, and prognosis.

“As I begin my early career in endocrinology, my goal remains the same — to provide a better future for patients in the community and abroad, where medical complications and emergencies can be prevented with education, guidance, and compassionate care.”

Seeing their lack of resources, I worked to provide them with donations of medications, diabetes supplies, and a simple fridge to store insulin in the clinic. We observed our patients through the years and saw them get better over time; we saw the rate of diagnoses and treatment of their diabetes improve. All they needed was education and it was amazing how much that changed their lives.

I continued to see a trend as my career progressed – lack of health education and awareness leading to poor health outcomes, especially with diabetes and obesity. In residency at Yale, I met Lara a 22-year-old naturopath who presented to the hospital in diabetic ketoacidosis (DKA), her HgbA1c was 15. She was diagnosed with type 1 diabetes at the age of 18 and despite medical advice to take insulin, she relied on Chinese herbs and a full carb restriction to treat her condition. When asked why she did not want to take insulin, she answered, “Why do I need it when I don’t eat carbs?”

Our team educated her on why insulin is necessary to stay alive, and she told us that we were the first people in three years to tell her this! She stopped all herbal medications and became a patient I continued to follow in clinic. Luckily she was never admitted for DKA again.

I found the stories of diabetic patients empowering and felt compelled to change their lives for the better through education and spreading awareness. With the guidance of my former program director, Stephen Huot, MD, PhD, and the rest of the Yale Primary Care team, I discovered new outlets to share the importance of preventative medicine with the community. I worked with him to coordinate health fairs to provide preventative care and disease screenings to thousands of people in the community. Throughout residency, I spoke on diabetes and obesity prevention on the radio and at various events throughout the area. I began to realize the power of media, and started to blog routinely on various health topics.

During my continuity clinics in residency I learned how to provide thorough and compassionate care from my mentor, Andre Sofair, MD, MPH. He cultivated me into becoming a more thoughtful physician, and understanding a patient for who they are, and to not be blinded by a diagnosis. Many of my clinic patients struggled with obesity and diabetes. I saw firsthand how complicated these diseases truly were, and I struggled through the good and the bad times with my patients.  My colleagues used to refer their own difficult cases of diabetes and obesity to me as a resident because they knew I enjoyed these patients the most.

I loved the challenge of taking care of difficult patients who struggled with non-compliance or who posed as a clinical dilemma. I found myself fascinated by the physiology of diabetes and obesity. Most importantly, nothing else brought me greater satisfaction and happiness than seeing my diabetic patient’s A1c improve or my obese patients lose weight. Most often these patients did better because I spent the time educating them and answering their questions. I was intrigued with the power of lifestyle change and how it cured some of my diabetic patients. Outside of diabetes and obesity, I found myself drawn to other areas of endocrinology like pituitary and thyroid disease. I always chose endocrine cases to present at conferences and rounds because I found the physiology of hormones and feedback loops so interesting. By my second year of residency, I knew endocrinology was my calling.

During my fellowship training at Yale I was lucky to have compassionate mentors like Silvio Inzucchi, MD, who introduced me to the world of endocrinology, and so many interesting patients. He taught me how to think outside of the box and improve on my physical examination skills to make a diagnosis. His zest for teaching inspired me to pursue a career as a clinician educator. While working with him and all the outstanding faculty members in the division of endocrinology at Yale, I realized that a career in endocrinology will never be boring. Every case was different, and every case can be learned from. I felt that more than a doctor every day, I was an educator. I was a teacher to not just my patients, but to other colleagues and students about endocrine diseases.

“I am so thankful every day for the wonderful mentors in my life, and the gift of patient stories that we as physicians are so lucky to hear.”

Endocrinology is now my outlet to continue my work as an educator and as an advocate to make a change in this world. The patients that I see every day fuel my interest in medical journalism – where I utilize their stories and circumstances to spread education and awareness to people throughout the world. I use media to share a message of prevention and recognition of many endocrine diseases, especially diabetes and obesity. As a member of the Endocrine Society, I have also had the opportunity to continue this work with Society members who share in my vision and passion. I work closely with the Endocrine Society’s Hormone Health Network to spread awareness on various endocrine diseases through patient education tools and media.

As I begin my early career in endocrinology, my goal remains the same — to provide a better future for patients in the community and abroad, where medical complications and emergencies can be prevented with education, guidance, and compassionate care. I am so thankful every day for the wonderful mentors in my life, and the gift of patient stories that we as physicians are so lucky to hear.

 

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