February 24th, 2019

Why Choose Infectious Diseases as a Medical Specialty? Here’s the Beginning of My Story, with Bonus Podcast

I got this from gefilte fish? oy …

Forgive the autobiographical nature of this post, but here’s a recap on how I started down the the path to becoming an ID doctor.

To begin, understand that my first year of medical school was rough going.

In hindsight, this wasn’t surprising. After majoring in English during college (with a minor in the Harvard Lampoon to develop good study habits, ha ha ha), then spending a year abroad teaching, I found medical school’s unrelenting science courses and lecture hours an unpleasant blend of overwhelming and tedious.

Meanwhile, most of my classmates were cruising — including my future spouse, who attended all the lectures, took meticulous notes in colored pencil, and aced every test.

Ouch.

Any jealousy I felt about her breezing through the first year of med school was more than compensated for by gratitude — hard to imagine I’d have made it to second year without her.

And so glad I stuck around, because our second-year microbiology course gave me a strong signal that I might actually like this medical business. Led by the articulate and worldly Dr. Arnold Weinberg, and ably taught by other superb teachers and section leaders, the course was endlessly stimulating, the very opposite of the metabolic pathways I had (barely) memorized during first-year biochemistry. I looked forward to every microbiology lecture and every lab.

I loved this course for multiple reasons:

  • Each disease had a story. The legionnaires’ convention in Philadelphia, the contaminated cooling tower of the hotel’s air conditioning system, and the (appropriately named) new disease due to Legionella pneumophila! The makers of gefilte fish at home who later developed Diphyllobothrium latum! The river rafters from Ethiopia who developed fever, myalgias, and eosinophilia and were ultimately diagnosed with Schistosoma mansoni! The visitor to the deserts of southern California with fever, pneumonia, skin lesions, and Coccidioides immitis! 
  • The names of the bugs were so poetic. Just look at that previous paragraph — each microbe a musical mouthful of letters and syllables. Even the more common bugs sounded exotic and fascinating to my ears: Streptococcus pyogenesEnterobacter (now Klebsiella) aerogenesStaphylococcus saprophyticusPseudomonas aeruginosa, Plasmodium falciparum. Just read those names out loud — heaven! And does anything sound scarier than Toxoplasma gondii?
  • Even the lab was fun. My experience in science labs had at that point been limited to dry exercises in organic chemistry as an undergraduate, and some snooze-worthy histology and pathology labs during first year of medical school. Microbiology lab, however, was a whole new ballgame — culture plates, strange smells, actually seeing the bacteria and parasites under the microscope, and helminths in clear vials. It didn’t hurt that one of my section leaders was the extraordinary pathologist Dr. Franz von Lichtenberg. Franz’s enthusiasm for the material was 100% communicable — and yes, I chose that word intentionally.
  • This new, mysterious disease — AIDS — had just been identified. It was during microbiology that we first had lectures on this new problem. We didn’t know yet what caused AIDS, but a sexually- and blood-transmitted infection seemed likely — one of our lecturers posited that it would be cytomegalovirus. (He was wrong.) Plus, the vast majority of the complications were infectious, most of them rarely seen in patients with normal immune systems. Could there be anything more fascinating — and important — than an infectious disease that could be rapidly lethal in previously healthy people?

After microbiology, the rest of medicine became much more interesting. Cardiology had endocarditis and rheumatic fever; pulmonary had pneumonia, empyema, and lung abscess; renal had pyelonephritis; neurology had meningitis, encephalitis, and brain abscess. You get the idea.

Everyone I knew thought I’d end up an ID specialist. After all, I was the only one who had memorized all of the oral and intravenous cephalosporins, a party trick I still bring out for the right company if they ask nicely.

And after a brief flirtation with cardiology, I haven’t regretted my choice of ID one bit.

Medical school microbiology was my start down the road toward ID, but there are multiple other reasons I chose it. Another ID enthusiast is my longtime friend and colleague, Dr. Raphael (Raphy) Landovitz from UCLA. To elucidate these reasons further, I invited him to join me on an Open Forum Infectious Diseases podcast, where we drafted the Top Five Reasons to Choose ID as a Specialty.

You can listen now on the site, and even read along with the transcript.

Or grab it on iTunes, or Overcast, or various other podcast charging stations.

Have fun.

13 Responses to “Why Choose Infectious Diseases as a Medical Specialty? Here’s the Beginning of My Story, with Bonus Podcast”

  1. Kimberly Holding says:

    just reading this causes that excitement of all the bugs, drugs and parasites that are still as fascinating as the first time I learned them. at Tulane, they referred to us as the “Thinkers “; History is everything and everywhere in infectious disease! love a good story!

  2. Marvin Rabinowitz says:

    I am a USFMG who went to a French med school where a thesis is required for your diploma. You choose your mentor who then assigns the topic. My mentor was in the medical ICU and my topic was infections in the liver. I was hooked.

  3. Tom says:

    Paul,thank you for such inspiring story.
    Recently I found that ongoing research continues to show great promise for the use of HGH for AIDS patient.One of the most important benefits of HGH therapy is the impact it has on decreasing the viral load when used with anti-HIV medications. In previous studies, HGH was found to increase the size and function of the thymus gland. This organ located beneath the breastbone produces naïve T-cells that can then increase CD4 cell counts. HGH improves thymus gland size and functions through its role in stimulating cellular regeneration. By promoting the liver to secrete insulin growth factor 1, HGH brings about the production of its own mediating hormone IGF-1.https://hghtherapydoctor.us/hgh/benefits-of-hgh-for-aids-patients.
    What do you think about this?

  4. elias azar says:

    super really thank you

  5. Bruce G. Howard MD says:

    I am a retired physician who practiced three years as a pediatrician (one year of residency and two years in the USAF) and 45 years as a non-academic dermatologist (three years of residency and 42 years as a solo practitioner, a county clinic physician, and an employee in a group dermatology practice). The American Board of Dermatology dropped Syphilology from its title several years before I became a diplomate. I supervised a weekly county STD clinic for 30 years and consulted in an HIV clinic for about 15 years. I spent a total of five months as a volunteer dermatologist outside the US from 1970 until 1985, during which time I became proficient in the diagnosis of Hansen’s disease.

    I concluded after retirement that if I were to choose a specialty now, it would be infectious diseases, which is what linked pediatrics and dermatology for me.. I regretted that the specialty of dermatology did not continue to play a major role in HIV and AIDS after the early years.

  6. Vivek Nayak says:

    Most of the diseases that physicians treat have no cure. where as 75% of conditions treated by ID physicians cna be cured. That is what is fulfilling.

  7. BK Titanji says:

    Nothing appeared to hold the same appeal or capture my imagination as much as ID . Thanks for sharing your story. I’m loving every moment of ID fellowship and no regrets in sight. Great specialty which attracts fantastic people.

  8. Joel Gallant says:

    I was drawn to ID by my fascination with parasites, which sometimes had even better names than bacteria. Who can resist the names Iodamoeba bütschlii, Opisthorchis sinesis, Paragonimus westermani, Wuchereria bancrofti, or Loa loa (which sounds like it should be a song by The Kingsmen).

  9. Dr. Rohini Roopnarine says:

    As a veterinarian, we deal with so many zoonoses that regular physicians don’t seem to often consider on their differentials-Lyme, Lepto, Toxo….Are the topics of zoonoses and the role of animals as reservoirs of diseases impacting human health covered then in infectious disease residencies in Medicine?

    Best wishes
    Rohini

  10. Jaan Naktin says:

    Thanks Paul for the blog post and the podcast. I often reflect on my choice in this modern medical era, and ID is one of the few medical specialties that still honors the process of discovery and investigation. I thought for sure you would bring up the Zinsser quote which sums it up quite nicely:

    “Infectious disease is one of the few genuine adventures left in the world. The dragons are all dead and the lance grows rusty in the chimney corner. … About the only sporting proposition that remains unimpaired by the relentless domestication of a once free-living human species is the war against those ferocious little fellow creatures, which lurk in dark corners and stalk us in the bodies of rats, mice and all kinds of domestic animals; which fly and crawl with the insects, and waylay us in our food and drink and even in our love”

    It should probably be somewhere in our mission/vision statements as professionals.

  11. Wally Schlech says:

    First exposed as an FMF corpsman to the nuances of malaria then hooked by Ben Kean’s 2nd yr parasitology course at Cornell. 2 yrs at Special Pathogens at CDC studying outbreaks of TSS, Legionnaires disease, histoplasmosis, and listeriosis. Took care of the first HIV patients in Nova Scotia in ‘82.
    ‘Now a superannuated academic still doing ID including a number of sojourns teaching and clinical care in Africa and India. Never regretted the choice of ID and still having fun!

  12. Martin J. Raff says:

    Having had a similar background I understand your choice. While a graduate student in microbiology one of my professors asked why I did not go to medical school at the same time, and gave me a dozen reasons why this made sense. Moonlighting in the hospital micro lab led to rounds with the ID team and a fascination with the organisms, the epidemiology and the problem solving. Academics was a clear choice after fellowship in ID after residency, and I founded an ID division at a midwestern university. Great career. Became convinced that, with few exceptions, diseases were due to infection or to the hosts’ responses to microorganisms that surround us. This is becoming increasingly obvious and the future of investigations in ID has no limits. Recommend it to anyone who likes to think out of the box, associate closely with patients, assist physicians in other disciplines and continuously learn new diseases and therapies. Thanks for your description of your interest in this great field.

  13. Christine Hamilton-Hall says:

    I started to appreciate the specialty of Infectious Disease our junior year, when I figured out I had Giardia (from that sushi restaurant on Newbury & Mass Ave that is now a pizzeria), not hepatitis (as diagnosed by the geniuses at student health). Infectious disease experts have been the most useful consultants I have had throughout my career. You are the unsung (and sometime sung) heroes!!!

Leave a Reply

Your email address will not be published. Required fields are marked *

Note: This is a moderated forum. By clicking on the "Submit Comment" button below, you agree to abide by the NEJM Journal Watch Terms of Use.

Our physician bloggers cannot respond to requests for personal medical advice, and recommend patients discuss health issues with their individual physicians.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.