|Year : 2018 | Volume
| Issue : 7 | Page : 1-2
Endocrinology: The way forward
Consultant Endocrinologist, P.D. Hinduja Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||9-Nov-2018|
P.D. Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai - 400 016, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chadha M. Endocrinology: The way forward. Indian J Endocr Metab 2018;22, Suppl S1:1-2
Three decades of my life in Endocrinology; that is more than 50% of my life!
How things have changed from 1980s to the current phase of life!!!
A number of thoughts cross my mind as I sit down to pen my thoughts and to dwell on the past and ponder on what we can expect to see in the next decade or so.
| The Past|| |
Compared with the other superspecialties like cardiology and neurology, endocrinology was in its infancy in the 1970s to 1980s. The first DM Degree in Endocrinology was started in 1969 at PGI, Chandigarh, followed by BHU, Varanasi (1976), KEM Hospital (1983), and AIIMS (1984). A decade after that, a number of new centers started offering superspecialization in Endocrinology. As a result, while we were adding 8–10 Endocrinologists every year in the 1990s, this number is now close to 100 every year. Along with the increase in the numbers, there has been a significant improvement in the quality of training and research opportunities.
Endocrinology was predominantly a clinical branch because of a lack of investigations. For instance, obtaining TSH, T4, and T3 assays was a big deal. I remember during my Residency, these assays were done for the patients in the hospital only after our clearance. Other assays such as ACTH and PTH were offered by a few private laboratories but were often unreliable or very expensive. Most assays were just names we read in Journals. Very often the diagnosis was a clinical one and the etiology was unclear. They were often labeled as idiopathic or attributed to tuberculosis. The emphasis was on symptomatic treatment and not on diagnosis!
| The Present|| |
Hormonal assays are freely available (and reliable to an extent) and affordable.
Rapid strides have been made in Ancillary specialties. Finding the source of FGF 23 today generally takes 24–48 h, whereas in the past there have been cases where we had removed the FGF-23-producing tumor after a decade of symptomatic treatment. There is now an emphasis on trying to find the etiological diagnosis. Endocrinology – a fascinating specialty – is now a sought-after branch among postgraduate aspirants. Although the number of qualified Endocrinologists has increased considerably, there is still a great shortage considering the size of our population.
“Info Obesity” or the information overload has increased the demand for specialists, and this too has contributed to the widening gap between the number of trained endocrinologists and those needed for patient care. Currently, Physicians and Family practitioners are trying to fill in this shortage, which often leads to mismanagement. There is a great opportunity for the young Endocrinologist to narrow this gap – by serving in a teaching institution or in private practice.
| The Future|| |
I see clinical medicine losing its importance. Diagnostic tests would reach a new plane and there would be panels of tests done before the patient reaches the Endocrinologist. Genetic testing would be ordered as one does TSH today. The group of idiopathic disorders would shrink further to a bare minimum. The focus of management would be on early diagnosis, familial genetic screening, and prevention or early therapeutic intervention.
On a different note, doctors have become very busy and patients increasingly have greater access to medical literature. This has resulted in a strained Doctor–Patient relationship. Our society is going the Western way, and there are more occasions of litigations or attacks against doctors. Fear of litigation is responsible to a degree for defensive medicine. Investigations are being ordered not only for diagnosis but also to be sure that no other condition is being missed. “Incidentalomas” discovered during a number or routine investigations are a significant cause for references to Endocrinologists. The only way forward is to give enough time to these patients till such time that their queries are answered. In situations where the doctor decides he cannot do justice to the patient, he should refer the patient to a more accommodating colleague!
As members of our Society, we need to stress the importance of the following:
- Shared decision-making in deciding the course of patient care
- Working on interpersonal relationship and networking for furthering true and genuine academics
- Respecting seniors and colleagues.
The mission statement of our Society formulated in 1971 clearly gives insight into what our role is and it is stated as below for the uninitiated:
- Develop guidelines for Standard of care
- Identify few Centers of excellence for specific diagnostics or therapeutics
- Central registry for common disorders to document the natural history of the disease
- Central registry for rare disorders
- Develop patient/public outreach programs
- Have an Advocacy group to influence governmental decisions pertaining to Diabetes and Endocrinology.
In my opinion, that mission statement is still relevant and outlines the way forward to ensure that we as a society contribute to improving the health of the nation. We need to be responsible members of Endocrine Society of India and the Society at large!
I can also identify with the growing challenges that the future generations would face, and am proud of the role the Society plays in encouraging Research and organizing the training of postgraduates.
We must adapt to a world that is being hit by a Tsunami of technological changes. I will sign off with this quote from Charles Darwin “It is not the strongest of the species that survives, nor the most intelligent, but the one most adaptive to changes.” This applies without swerving from Hippocratic philosophy of “to help, or at-least do no harm”!