Pathology, Endocrinology.

I spent the morning shadowing a pathologist. I've been in and out of the clinical labs a few time with other physicians, but haven't spent more than a few minutes at a clip in there. I was first given a tour of the gross cutting room and the slide preparation area, which was interesting. I haven't taken a histology course yet, but I understood most of the procedures they described.

After the first batch of slides were ready, Dr. B and I sat down at one of the multi-headed microscopes and proceeded to look at them. Again, since I don't have much a histology background, I could only differentiate the most obvious structures (fat cells are pretty obvious, for example). Dr. B was pretty good about explaining things, though I was somewhat lost when he pointed out some of the more minute details.

I think it's safe to say that pathology is one of the most cerebral, intellectually-demanding fields in medicine. The amount of knowledge a pathologist must acquire is staggering, and the field definitely attracts a certain personality type - generally those who don't particularly need direct patient contact or a lot of recognition for their work. In exchange for their relative obscurity, pathologists enjoy fairly normal schedules and are compensated quite nicely for their work. With all the new molecular and genetic tests, there is even room for specialization within the field. I'm not convinced that pathology is the field for me, but I can definitely understand why someone would find the field attractive. As much as I love surgery and the excitement of the OR, I am well aware of the kind of lives surgeons lead. Pathology is something to keep in mind for sure.

In a rather abrupt shifting of gears, after lunch I made my way into the clinic to shadow Dr. L, an endocrinologist. As much as I enjoy molecular signaling pathways, I found the actual practice of general endocrinology to be rather bland. Perhaps that is because of the thirteen patients we saw, at least nine were diabetes management cases. I asked Dr. L how many of his cases were diabetes patients, and he said that is was upwards of 90%. So, if you absolutely LOVE diabetes and want to spend your entire career checking glycohemoglobin levels and twiddling with insulin doses, endocrinology is the field for you. Personally, I'm already sick of listening to patients bullshit about why they haven't gotten their blood sugar under control/haven't lost weight/haven't done anything to help themselves, so I think I'll pass.

To be fair, I did see some moderately interesting things. There was a 10-year old girl who had apparently begun showing signs of puberty at age 8, but was otherwise healthy. I saw a few hypothyroid cases, though they were all follow-ups and didn't require too much adjustment of medications. One patient had hypothyroidism and adrenal insufficiency and was on medications for both.

Anyway, it was a rather long afternoon and I was not too disappointed to leave. I doubt I'll be clamoring to shadow endocrinology again anytime soon, but you never know.