Post Date April, 15 2023
Previously, in a professional WeChat group, a girl with a seven-year clinical medicine degree who was studying in her fifth academic year raised the following questions:
Did I take the wrong medicine and choose nephrology?
In the department of nephrology, I felt that the patient could not be cured at all, and finally reported to the dialysis room!
I really don't understand where the sense of achievement of a nephrologist comes from!
With this remark, many divers in the group couldn't stand it anymore. They emerged from the water and gave the student some humming instructions, explaining many reasons for choosing nephrology. To summarize briefly, and add my personal thoughts, I have compiled the following text.
Intrarenal diseases often involve various fields and cross multiple disciplines, such as cardiovascular medicine (heart and kidney are not separated), respiratory medicine (uremia, heart failure, respiratory failure, Goodpasture, etc.), rheumatism (systemic lupus erythematosus, Sjogren's syndrome, and other autoimmune diseases), endocrinology (diabetes, nephropathy, and Batter syndrome related to renal tubular acidosis), vascular surgery (arteriovenous fistula) General surgery (abdominal dialysis catheterization, parathyroidectomy), and so on, only you can not imagine, without you can not do.
Nephrology is currently the most comprehensive subject in evidence-based medicine. The most typical is the various professional guides and updates provided by the KDOQI and KDIGO in the United States on various fields of nephrology. It is difficult to see similar situations in any other discipline. The significance of sufficient evidence is that for almost all common clinical situations, you can find answers in the guidelines, which greatly reduces the intensity of direct clinical experience, allowing you to enter the situation in a relatively short time without deviating.
The nephrology profession requires strong basic internal medicine skills and rigorous clinical thinking skills. In the simplest way, a patient with primary nephrotic syndrome has arrived. Through some medical history characteristics and clues in clinical manifestations, it is possible to roughly determine the type of pathological changes and sensitivity to hormone therapy. This process is somewhat similar to a detective's decision, filled with the unknown and a sense of accomplishment after solving a case. If you make a wrong judgment, it doesn't matter. You have added your own clinical experience.
The number of patients in the department of nephrology is large, and there is no need to worry about having no patients. According to epidemiological statistics, the proportion of chronic kidney disease patients in the population is about 10%, in other words, every 10 people on average are likely to be chronic kidney disease patients. What a large group of patients this is! Of course, the low awareness rate leads to less spicy patients actually coming to the hospital, but does this not exactly explain the importance of our work?
Nephrology is a relatively new discipline with a huge room for improvement. In our country, in 1977, the first national conference on glomerular disease was held in Beidaihe, and this was the first year of the development of the kidney disease profession in China. In other words, the major of nephrology in China is still under 40 years old. How young! However, in her 40s, it is a golden age for a person to grow up. For this discipline, it is now a period of rapid growth in which she has made great strides. Entering this major right now coincides with the era of great development of nephrology in China, and will definitely become a person who has personally experienced this period of history.
The department of nephrology can be further subdivided into many sub majors: those who like the basics can engage in various pathways, genes, and experiments. Making a SCI is not a problem. If there is a big discovery, winning a Nobel Prize is not a dream; With so many patients in the nephrology profession who like epidemiological investigation, it is not a problem to screen out some patients who meet the experimental design, while the rate of missing visits is relatively low, making them very good experimental subjects; For those who like to engage in pathology, renal pathology is a relatively independent branch of pathology. If you understand it thoroughly, you will not be afraid to travel around the world; People who like to use their hands and feet, have many professional renal procedures, such as renal puncture, internal fistula establishment, central venous catheterization, peritoneal dialysis catheterization, interventional nephrology This is something that other internal medicine departments dare not reach; I like to deal with patients. Most of the patients in the renal ward are old face patients, who chatter and often use drugs to solve their difficulties. I feel like a neighborhood committee aunt, and it's also very good! In summary, in nephrology, there is always one for you.
There are many unknown areas in nephrology, which means there are still many things we can do. For example, the significance of the recently discovered phospholipase A2 antibody in the differential diagnosis and prognosis of membranous nephropathy is a typical example. In many fields, although the mechanism is relatively clear, it still requires clinicians to find ways to achieve it in clinical practice. The most typical is the standardized diagnosis and treatment of CKD-MBD. With a little effort, you can significantly change the prognosis of patients. Can you still say that kidney physicians have no sense of achievement?
In many hospitals in China, nephrology is still a marginal department, unlike popular departments such as orthopedics and cardiology, where a large number of people break through their heads to enter. Therefore, it is relatively difficult, with fewer nepotism, and it is easier to handle people and things. At least, there are fewer relationships with hospital leaders. Moreover, in an environment where competitive pressure is relatively low, as long as you make a little effort to stand out or anything, it is not a problem. This is one of them! Ha ha, how utilitarian!
