The AAMC team (as part of our Specialty Perspectives series) recently sat down with Dr. Pasricha to learn more about her work. Learn more about internal medicine and GI below.
Can you provide a description of your work?
I am an instructor of medicine at Harvard Medical School as well as a neurogastroenterologist, meaning I see patients who have disorders of gut-brain communication and perform endoscopies. I also run a clinical and translational research laboratory.
What attracted you to internal medicine and GI?
As everyone does in medical school, I rotated through many different specialties. I really felt that the gastroenterology people were my people. Everyone that I met in GI had such a great sense of humor and was very relaxed. I felt at home.
I knew I wanted to do internal medicine because, to me, internal medicine is what being a doctor is all about: thinking about the body as a whole and how all the systems work together. In any sub-specialization within internal medicine, you are always an internist, meaning you never lose sight of the bigger picture of the patient in front of you. What’s unique about GI is that you are still thinking carefully about all of the aspects of a patient’s current symptoms, but you also get to perform investigative, hands-on procedures like colonoscopies and endoscopies. This procedural skillset becomes an extension of your physical exams, which is unique in internal medicine.
How would you describe a typical workweek?
As a physician-scientist, I spend most of my week in my laboratory either recruiting, talking, or doing studies with patients. I see patients part of the week, both in the clinic and while performing endoscopies. I have a nice mix of getting to meet patients and learning how I can help them, which inspires me to think about what questions we need to be asking in the lab to help them most.
What previous experiences have helped you most in GI?
Growing up playing video games really helped me as an endoscopist (parents everywhere will rejoice)! The hands-on skills of translating what I am doing with my hands and watching the screen as I am navigating a colonoscopy came from playing video games.
I have a master’s degree in public health instead of a PhD, which is more common for physician-scientists in my field. My master’s degree trained me in biostatistics and epidemiology, both of which are very important in building the foundation for the research I am currently doing.
What’s one thing you wish someone would’ve told you before going into internal medicine?
When you’re a premed, you can become caught up in acing your premed classes, like organic chemistry and physics. These classes are very difficult, and on top of that the pressure and competitiveness that comes with applying to medical school can be all consuming. All these challenges premeds face make it easy to lose sight of the bigger picture that you are becoming a doctor so you can help people! When I was a premed, I found myself forgetting the bigger picture of what I was actually doing and instead focusing only on the next step in my journey into medicine. Thinking this way can distract you from the purpose of all your hard work. Focusing on your longer-term goals will help you get through the long journey into medicine.
Students also spend a lot of time shadowing physicians, but they will likely never do some of the things a physician will have to do. As a student, you should take the time to ask physicians about the good and the bad parts of their job to get a better understanding of what you are getting into.
How would you describe someone who would excel as a GI physician?
GI has a reputation for focusing a lot on endoscopies, also called a “scope.” I think someone who would do well in GI is someone who focuses a lot on the scope while still looking at the whole person. Someone who is willing to integrate all the information they can from the patient is very important. Just because you are in GI does not mean you shouldn’t consider the heart or the lungs. You need to remember that while you are a gastroenterologist, you are a doctor first.
Can you share a case you found especially rewarding?
One thing I study is how the gut and the brain communicate with each other, which is called neurogastroenterology. I often study how Parkinson’s disease, which most people don’t think of as a GI disease, might originate in the gut and how the gut can be a harbinger of future neurodegenerative disorders.
A few years ago, I started to see patients with Parkinson’s disease, many of whom had GI issues. I noticed a pattern of many of them telling me they had ulcers when they were younger. There hadn't been much in literature about how these two issues were related, so we conducted a large study in my lab to try to figure out what that connection was. What we found is that patients who have a history of peptic ulcers are at a 76% increased risk of developing Parkinson’s disease more than a decade later. Now our lab is trying to figure out what the mechanisms involved are and why this occurs.
Is there any advice you’d like to share with premeds?
From time to time in my career, I’ve liked going back to the essay I wrote as a premed to apply to medical schools. Remembering how you feel, right now, as a premed and why you want to go into medicine is so important. Keep that piece of yourself intact as you apply to medical school and go through this journey into medicine.
To learn more about Dr. Pasricha and her work, follow her on Instagram.