COMMENTARY

On Being (an Endocrinologist): One Personal Journey

Ann Danoff, MD

February 28, 2017

Editorial Collaboration

Medscape &

As a child, I fell asleep each night to the wonderful piano music of Chopin, Bach, and Beethoven, played by my grandmother, who lived downstairs. This melodious music was often juxtaposed with the cacophony of my parents' friends, meeting in the living room and arguing about how to make the world a better place.

Ann Danoff, MD

I was baffled that people who shared such a lofty goal fought so vociferously with each other. It was incomprehensible that these people who were willing to put their lives on the line for strangers were not always nice to their closest friends. That disconnect was more than I could bear, so I opted out of overt political activity and became a professional dancer.

Then, a serious back injury changed my path. My dancing days were over, and I needed to find a new career.

I was visiting with a dear friend who was a molecular endocrinologist, when I noticed a book on his bookshelf: Cells and Organelles, by Novikoff and Holtzman. I picked it up and started reading, and it was love at first sight.

To me, it was the most magnificent choreography I had ever encountered: the inexpressible beauty of the dance of receptor/ligand couplings and intracellular transport.

Back to college it was, first to get a bachelor's degree, and then to find a medical school willing to take a risk on a dancer. (Thank you, Dean Hartman and the Medical College of Pennsylvania.)

A New Chapter

I was one of those students who loved almost everything. But the diversity, complexity, and depth of internal medicine led the pack. The next choice came when I had to decide between general medicine and a host of subspecialties. Endocrinology won by a landslide.

I have no regrets about that. Being an endocrinologist has been a wondrous journey, and an amazing privilege.

Why do I love endocrinology so much? Let me count the ways.

I know this does not win hearts and minds, but I love the science first and foremost. The big physiology (our feedback loops) make sense. And when they don't make sense, you know that there is a hormone out there just waiting to be discovered.

Those beautiful cells: the intracellular processes that are a work of art, creating order out of what frequently seems to be a chaotic universe.

And, yes, the patients. We see such an amazing mix of patients, from those whose lives are improved forever with the simple replacement of a missing "natural" substance, to those struggling with a chronic illness, where our professional kindness can sometimes make all the difference in the world.

I love the range of diagnoses and treatments in endocrinology. Some are obvious (to an educated observer), and you can make the diagnosis the moment you lay eyes on the patient in the waiting room. Others are more subtle, and a diagnosis requires careful detective work and nuanced consideration.

I cherish the privilege to be fully present with patients in a most intimate manner, and the satisfaction of being able to speak to people about their medical concerns in language that they understand.

Of course, I also love the opportunity to do research—to have the honesty and courage to admit how little we really understand about anything, and try to shed some light on this very complicated world we are passing through. In endocrinology, the "translation" from bench to bedside has always been especially tangible to me, and is another one of the many things I love.

Finally, I love to teach—what a joy to pass on lessons learned, and to (hopefully) nurture caring and inquiry in others. And they pay you for it, too!

Where's the Rub?

The most obvious issue (although not the top of my personal list) is the fact that endocrinologists are not paid as well as many other specialists. That can get under your skin and fester. With more women entering the field, the pay gap with other specialties will almost certainly widen, unless the next generation continues the fight for gender equity.

Several other concerns compete for the top of the list, and are contributing to the dehumanization of our profession. These are not unique to endocrinology, but rather are affecting and demoralizing an overwhelming majority of us working in many areas of healthcare.

How has a profession that was a sacred calling been so diminished? We are intelligent, dedicated individuals who demanded of ourselves not just a sound knowledge base, but also adherence to the highest ethical and humanistic standards.

When did we agree to accept marching orders from corporate leaders? Why did we acquiesce to infantilization by "report cards" drawn from dashboards populated with metrics that make no sense to the thoughtful, hardworking people on the front lines?

And, of course, there is the electronic medical record (EMR)—the motivating force behind the early retirement of many colleagues. Having worked in a system that led the way in implementing the EMR, I confess that I like much of what it has to offer. But what a challenge to figure out how to use it optimally, for care, research, and education, and not as a barrier standing between one human being (the patient) and another (the physician).

And then there are the very hard realities of dealing with an unending stream of sickness and neediness, and the personal sacrifices made in the interests of our patients that seem to transcend time and space. For those working in medically underserved areas, the daily confrontation with the inequities in healthcare (and life) adds another layer of burden.

In more affluent practices, jumping through the hoops designed by the for-profit parts of the "industry" has taken on a life (and a business) of its own. And now, rather than being supported for all of the energy, passion, and tenacity that is required to face the daily parade of suffering, we receive monthly reminders of our "deficiencies," or at best, a mercenary performance pay bonus that completely misses the point of what is entailed in this very difficult "job."

Getting Involved

Like others of my generation, I have witnessed amazing advances in medicine and endocrinology. I have also witnessed what many consider a profound erosion of our profession.

In these troubling times, where fundamental aspects of human decency are under fire, I have deep concerns that the humanism that is the bedrock of the art and science of our profession (and of a civilized society) will endure. Guided by lessons learned many years ago from my parents and their friends, when Chopin mingled in the air with politics as I drifted off to sleep, I implore you to identify issues facing our profession and our nation that you are passionate about, and join forces and take action.

There is no shortage of areas where there is room for improvement. Despite rumors to the contrary, global warming is real. There won't be any endocrinology or advancement of science if we destroy the planet.

If you believe that it is important that all people are well represented in the boardrooms across the nation, participate in pipeline programs to ensure that people of color, sexual minorities, women, and socioeconomically disadvantaged people get their rightful seat at the table, and speak up when leadership selections are being made.

Addressing disparities in diabetes and obesity, and putting an end to the use of endocrine-disrupting chemicals, are a few obvious targets closer to home for endocrinologists.

While every act of human kindness matters, individual effort may not be sufficient to achieve the greater good we so sorely need. Combine forces and fight together for yourself and your colleagues, the brave army of warriors embracing the sick and the dying, and sometimes escorting people across to the other side. Fight for the patients entrusted to our care, and demand a healthy, safe environment, and access to the highest-quality healthcare for all.

We are living in a time that threatens a profound reversal of advances made over the course of my lifetime. Stand up for what you believe and fight the good fight, for the survival of our honorable profession and for the rights of our less fortunate neighbors.

For those considering a career in endocrinology, I encourage you to go for it! If given the chance, I would do it again in a heartbeat, even in today's changed environment.

In association with the Endocrine Society

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