There are areas of medicine that can only be mastered properly if a doctor has the opportunity to see a sufficient number of patients with a particular condition on a regular basis, take part in the discussion of complex cases, and work alongside specialists who have devoted a large part of their professional lives to that condition.

It was precisely this kind of experience that I set out to gain in Lyon, France – one of Europe’s leading centres for the diagnosis and treatment of rare endocrine disorders, and pituitary disorders in particular.

Why France and Lyon in particular?

Latvia has a population of approximately 1.9 million. France is home to more than 69 million people – around 36 times as many. Meanwhile, the extensive network of university hospitals in Lyon and the surrounding area serves a huge patient population and makes it possible to concentrate patients with rare diseases in specialised centres.

This difference is particularly significant in the field of rare diseases.

If a disease is rare, there may be only a few such patients in a single country or in a single doctor’s practice over the course of a year. This means that even a highly experienced endocrinologist in Latvia cannot, on a day-to-day basis, gain the same clinical experience as might be gained at a specialist centre in France, where they see large numbers of similar, complex cases requiring long-term monitoring.

In Latvia, there are not enough patients to establish a highly specialised team of doctors for each rare endocrine disorder with a very high number of cases of that specific condition. Consequently, it is not possible to gain comprehensive experience of such diseases solely during residency training or in day-to-day practice.

This is not a shortcoming of Latvia’s healthcare system – it is simply the reality of a small country.

That is why, in my view, doctors should seek opportunities to gain this experience where it is concentrated.

Centre for Rare Pituitary Disorders in Lyon

My main professional experience was at the Hôpital Louis Pradel and the CRMR HYPO – a specialist centre for rare pituitary disorders headed by Professor Gérald Raverot.

It is the centre of the French national reference system for rare pituitary disorders and one of three specialist centres in France. The centre has been officially recognised since 2017 as Rare Diseases Reference Centre (CRMR), and since 2021, the Lyon centre has also held the status of a European Reference Centre (Endo-ERN) in the field of pituitary disorders.

Here, pituitary disorders are not viewed merely as a separate diagnosis. Patients are assessed by a multidisciplinary team comprising endocrinologists, neurosurgeons, radiologists, radiotherapists and other specialists.

It was particularly valuable to have the opportunity to take part in the assessment of complex patients and to see cases requiring a long-term treatment strategy, repeat surgical treatment, drug therapy, radiotherapy or a combined approach.

Professor Gérald Raverot – mentor

What made this experience particularly valuable was the opportunity to work under the direct supervision of Professor Gérald Raverot.

Not just listening to lectures or watching work from the sidelines, but to work side by side with a specialist who deals with the most complex pituitary disorders on a daily basis.

Professor Raverot allowed me to be present during the assessment of complex patients, to discuss diagnostic and treatment strategies, and to take part in the analysis of case studies.

Of particular significance was the opportunity to take part in multidisciplinary consultation meetings – both in the regional hypothalamic–pituitary disorders consultation and in national-level discussions on aggressive pituitary tumours and craniopharyngiomas.

Such an experience enables one to understand not only which treatment to choose, but also why this particular decision is taken in this specific situation.

This is one of the most important aspects, which cannot be fully grasped simply by reading books or guidelines.

Not just pituitary disorders

In Lyon, I also had the opportunity to learn about other rare and complex endocrine disorders.

The Endocrinology Department at Hôpital Louis Pradel brings together expertise in a number of areas relating to rare diseases – including adrenal disorders, rare or complex thyroid disorders, pituitary tumours, neuroendocrine tumours and other rare endocrine conditions.

Experience is also particularly important Autoimmune orbitopathies associated with Graves’ disease in treatment, where the Lyon centre serves as a European centre of excellence.

This specialisation makes it possible to concentrate expertise in one place, whereas in another country it might be spread across many doctors and healthcare institutions.

Why is this kind of experience needed in Latvia?

It was important to me to gain this experience, not so much to add to my professional CV, but mainly because It is not possible to gain clinical experience of this kind to the same extent in Latvia.

Latvia has excellent specialists and high-calibre medical centres, but, objectively speaking, our population of 1.9 million does not allow us to ensure the same concentration of patients for each rare disease as would be possible in a country with a population of over 69 million.

During their residency, a young endocrinologist can acquire a solid foundation in the diagnosis and treatment of all endocrine disorders. However, in the case of very rare diseases, this alone is not enough. To become a specialist in a particular field, it is necessary to see a large number of patients, including the most complex and atypical cases, to monitor the outcomes of their treatment and to participate in multidisciplinary decision-making.

In Latvia, it is not possible to establish a highly specialised group of doctors for every rare endocrine disorder with such a high volume of patients.

That is why I chose a different path – to go to places where this expertise is already concentrated, and to bring the knowledge gained back to Latvia.

Knowledge is not an end in itself

In my view, a doctor’s professional development is not just about acquiring new knowledge.

The most important question is – How will this knowledge change the way I work with patients?

My experience in Lyon gave me the opportunity to gain a better understanding of the diagnosis of rare pituitary and other endocrine disorders, the choice of treatment strategies, multidisciplinary patient management, and situations requiring international expertise.

I would like to apply this experience in my day-to-day work in Latvia – so that, in complex situations, I can offer patients a treatment approach that is as up-to-date, evidence-based and in line with international practice as possible.

After all, the point of such professional experience is not to feature on a doctor’s CV.

It is all about the patient.

The rarer the condition, the more important it is for the patient to have access to the knowledge and experience accumulated not just in a single doctor’s practice, but within the international community of professionals.

That is precisely why I chose to go to Lyon – to learn from doctors who, in their day-to-day work, encounter conditions that are extremely rare in Latvia, and to apply this experience when treating my own patients in Latvia.