Clinical Year: Endocrinology


At my program, we had 8 weeks of internal medicine total and could break it up into 2 separate 4-week rotations.  I did one of mine in general IM and the other in endocrinology.  My initial thoughts about endo were that I didn't know that much so I needed to do it, and lots of diabetes was in my near future.  

So what I learned on this rotations is that I was right that I didn't know much and that endocrine does see a lot of diabetes, but there's a bunch of other stuff too.  And there's a lot more to diabetes and treatment than we learn about in school.  Probably because they have new drugs and insulin more often now.  

My rotation was about 30 minutes away in a small town, and the office was a really cool old Victorian house (which I later found out was apparently haunted).  There was a physician and a PA and I was able to spend time with both of them.  The MD at this practice was a little picky about things, and would have a mini breakdown if you happened to forget the patient if they were taking aspirin or another minor detail.  I would always remind him that the patient was still there and go ask as promptly as possible.  Interesting dynamics in that office.  

There is a huge lack of endocrinologists right now, and that need is just going to grow as America continues to lack understanding about their health.  The patients would come in and have vitals done, occasionally a DEXA bone scan, and then be seen.  It's really important that diabetes patients keep a good record of their blood sugars, meals, and medications, especially if they are uncontrolled.  I would say about half of the patients actually brought these with them, which was a little frustrating.  The office I was in would do something called continuous glucose monitoring on patients that were having trouble getting their sugars under control.  Basically they wear a monitor for 3 days that takes periodic measurements of their blood sugar and then provides all kinds of graphs.  These can be done from blood glucose monitors too, but take a little more work.  If the patient is diligent about recording their meals and medications, that data shows when they may need more or less insulin or what meals they need to adjust.  It was really neat.  

Besides diabetes, there were also a lot of thyroid issues.  Whether it was hypothyroid or hyperthyroid or thyroid nodules or masses.  The MD had an ultrasound that he would do on patient's thyroids and he also performed fine needle aspiration biopsies as well when needed.  Those were very neat to see, and similar to what I had seen on my surgery rotation for breast mass biopsies.  

I went into this rotation thinking I was going to hate it, but I actually ended up liking it a lot.  In fact, I think if I wasn't working in dermatology, I would have looked for a job in endocrinology.  My husband is a 4th year medical student applying to internal medicine residencies right now, and I secretly hope he ends up doing an endocrine fellowship so I can work with him some.  I considered endocrine "lab medicine," and while labs are important, it's also important to talk to the patients and educate them on their disease state.  Unfortunately, I never saw the ghost of the little girl that had been seen multiple times in the office, but that's probably for the better.  I think doing this rotation helped me on boards a ton, and gave me a much better understanding of diabetes medications and interpreting thyroid labs, so I would definitely recommend doing one if you can!