COMMENTARY

Electing Endocrinology

Donald A. Bergman, MD

Disclosures

June 21, 2012

In This Article

Introduction

"When you run out of questions, you not only run out of answers, you run out of hope."
--House

Patients see endocrinologists for many reasons. They may be referred with a specific diagnosis, such as thyroid disease, metabolic bone disease, or diabetes. They may need nutritional support.

More often, however, they are referred because they have a bewildering array of symptoms, such as bouts of sweating, flushing, odd sleep patterns, abnormal hair growth, undiagnosable skin lesions, unexplained changes in weight, or fuzzy thinking.

The endocrinologist may be the patient's last hope in fitting together seemingly unrelated symptoms and arriving at a solution. This aspect of endocrinology is the most challenging, but in some ways is the most rewarding.

Most endocrinology patients have problems that can be diagnosed and treated early enough that they can feel completely well. Seeing a person with poorly controlled diabetes, for instance, and in a short period restoring order to that person's metabolism and preserving good health provides a feeling of accomplishment both for the patient and the physician.

In other instances, diabetic patients may arrive at the endocrinologist's office with neurologic and vascular complications caused by long-standing poor control. These patients pose the greatest challenge, and the greatest reward is seeing them become stable through the intense intervention of the endocrinologist working with the certified diabetes educator/nutritionist.

As an endocrinologist, you will also show patients the power of prevention. Unlike many other fields, where the skill of the physician is constantly required to treat or stabilize disease, in endocrinology patients can be taught how to prevent a disease or its progression through lifestyle changes that improve their health.

Patients can also be taught how to monitor the effects of medication, such as insulin, and report back to you when necessary. This freedom makes people feel empowered and helps in the healing process. Seeing an individual who is constantly breaking bones and then preventing further fractures through diet, exercise, balance training, and medication is a marvelous experience for both patient and physician.

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