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A conversation with Laurence Katznelson, MD
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In this issue, Endocrine Today talks with Editorial Board member Laurence Katznelson, MD, professor of medicine and neurosurgery at Stanford University School of Medicine and medical director of the pituitary center. He also is associate dean of graduate medical education at Stanford University. Katznelson’s clinical and research interests lie in the pathophysiology and treatment of pituitary disease. He chaired the Endocrine Society’s clinical guidelines task force that recently published recommendations for management of acromegaly.
Was there a defining moment that led you to your field?
Dr. Katznelson: My defining moment was not a moment per se, but an experience late in my residency. During my medicine residency, I knew that I wanted to have a career as a subspecialist, but I could not decide on a particular specialty. As a resident, my endocrinology exposure consisted of inpatient diabetes care, but not to other aspects of endocrinology. During my senior year as a resident, I did a rotation on the endocrine service and immediately found my calling. I was attracted to the multisystem manifestations of endocrine diseases, the cognitive aspects of the endocrine care that allowed me to sit back and think through problems, the ability to participate in clinical and basic research, and the focus on ambulatory practice. I then decided to apply to an endocrine fellowship.
What area of research in endocrinology most interests you right now and why?
Dr. Katznelson: My career focus has been in neuroendocrinology. As a fellow, I joined the neuroendocrine research and clinical practice, as I was drawn to pituitary diseases, particularly acromegaly and Cushing’s disease, as they were fascinating and reflected intriguing aberrations in biochemistry and clinical manifestations. My current research is clinical and focuses on the pathophysiology as well as therapy of pituitary tumors. Although such tumors are infrequent (particularly for the functioning adenomas), there is great excitement in work on novel therapies of these diseases. My clinical research also focuses on the prevalence and therapy of hypopituitarism, particularly regarding patients with traumatic brain injury. I find clinical research highly appealing, as I can apply my research findings directly to my patients. Additionally, I learn from my patients and generate studies based on clinical findings. Hence, I enjoy my research career in large part because my work has direct impact on the health of my patients.
What advice would you offer a student in medical school today?
Dr. Katznelson: The first bit of advice is to try out many different fields. Each field comes with a particular skill set as well as differing types of interactions with patients. By being exposed to many fields through rotations, you can learn what type of career appeals the most: Do you like intensive care vs. ambulatory settings? Are you attracted to procedural-based or more cognitive-type specialties? Do you want to focus on constant acute care, such as in the ED, or more chronic care in a clinic setting? Do you prefer nonclinical specialties? By scheduling diverse rotations, you can get a better sense of specialties that meet your career goals as well as the type of colleague and patient interaction that fits with your personality and interests.
Secondly, it is important to find a thoughtful mentor. Everyone needs a mentor — someone who can help guide you through your career. Although I have had several key mentors in my career, I have had one mentor from my fellowship who in particular has been a key person in helping me formulate my decisions as well as in handling difficult career and hospital scenarios. You should find someone who is available to you when you are in need, is responsive, listens to your questions and concerns, and can help guide you to the right persons or places to help find answers. You may find that you may need a different mentor depending on your level, and you should feel free to change mentors depending on such needs.
Have you ever been fortunate enough to witness or to have been part of medical history in the making?
Dr. Katznelson: When I was an endocrine fellow, I was fortunate to be exposed to the development of a novel medical therapy that changed the landscape of endocrine management. As a medical student and resident, we constantly took care of patients with malignancy-associated hypercalcemia. These patients were frequently admitted to the hospital for hypercalcemia, were treated with calcitonin, IV fluids and diuresis, and then discharged, only to return days later with recurrent hypercalcemia. This was highly frustrating from a patient care perspective, as we did not have drugs available that could maintain normocalcemia and control skeletal tumor burden. In fact, hypercalcemia was a common mode of death in such patients.
When I was a fellow, one of our faculty members was involved with a clinical research protocol involving the administration of IV bisphosphonate to patients with cancer in order to help manage the skeletal metastases as well as the hypercalcemia. That study, and many others, was highly successful, and bisphosphonates are now a standard part of the armamentarium against humoral hypercalcemia of malignancy as well as skeletal metastases. When I attend on the endocrine and internal medicine inpatient service, I am always struck by the fact that these patients are now managed as outpatients, and they are rarely admitted for management of hypercalcemia [that is] out of control.
What’s up next for you?
Dr. Katznelson: I have recently taken on an additional administrative position at the Stanford School of Medicine by becoming the associate dean of graduate medical education. This has been an interesting and exciting challenge, as this position presides over so many aspects of resident and fellow training, from centralizing educational programs, engaging house staff in quality improvement projects, maximizing professional behavioral attitudes, and improving the overall GME experience. This has been a terrific leadership experience and one that draws on my years as the endocrine fellowship program director to improve residency and fellowship programs in general. Instead of focusing on endocrinology only, I now challenge myself to find new ways to reduce stress and burnout in certain high-stress specialties, to enhance education in value and quality, and improve resident feedback. These are important challenges and I am enjoying this leadership position. – by Jill Rollet