Shannon Martin [not her real name] sees more than a dozen patients a week, demystifying scientific jargon and assuaging fears. A genetic counselor at a multispeciality group medical practice on the East Coast, Martin spends at least an hour with each patient, taking family medical histories and creating profiles for families and individuals with potential genetic predispositions, as well as for high-risk couples trying to conceive a child. Her organization has 300,000 patients, and her three-person department caters to all of its members with genetic disorders or those who have been deemed at risk by family history or genetic testing.
The Science Behind the Emotions
In February 2001, scientists announced the isolation of the gene that causes breast cancer to progress into malignancy. Part of a larger project to map the human genome, this discovery - and others like it - could lead to early detection and deterrence of a number of genetic disorders. However, just because a relative developed cancer at doesn't mean you're destined to follow along the same path.
"Most people come in much more scared than what their reality actually is," Martin said. "Their risks are usually much lower than they think."
Martin and her colleagues don't do the testing or research themselves. They strictly deal with the emotional repercussions of potential genetic risks, providing support and information to individuals and families of those who suffer from birth defects or proven genetic disorders. Through intensive documentation, a family history is pieced together and genetic risk assessed.
A visit with a genetic counselor is usually a good opportunity for people to discover more about their extended relatives. Taking a detailed history involves a lot of time and research. "I'll ask questions about people's family members that I probably don't know about my own family," said Martin.
Some people come to Martin with their genetic code already mapped out. People who have received genetic testing and show a predisposition for a disorder see Martin to help cope with their health risks. Others, who are simply at risk due to family history, Martin helps decide whether genetic testing is necessary. She points out that testing can help or harm, because the emotional and physical ramifications of the test can be tremendous. Martin tracks patients before, during, and after testing, acting as a medical interpreter and support staff if the information proves upsetting. Most of her patients are short-term, but a few use her services over long periods.
"The emotional side is very rewarding. You can get very close to the families," Martin said. "It's a hard time for most people, and if you can be there to help and listen to their questions, it means a lot to them."
A Burgeoning Field
According to the National Society of Genetic Counseling, a nonprofit trade organization, genetic counselors must hold specialized graduate degrees in genetic counseling. Coursework includes clinical, population, and molecular genetics; as well as psychosocial theory, ethics, and counseling techniques. Internships are necessary and field experience is essential. Martin holds a master's degree in genetic counseling, and remembers spending "countless hours" in internships during her graduate career. But she found the study of genetics captivating.
"I wasn't sure if I wanted to go into medical school or not, and I had a really great genetics professor in college. I found it fascinating," Martin said. "I like the science of it – the whole field is exploding."
The diversity of the field also attracted Martin. "If you get burned out in one area, you can find something new to do." When she first became a genetic counselor, the field was all prenatal or pediatrics-based, but it now includes all portions of the population. Plus, genetics as a whole is constantly advancing. "You have to read a lot, you have to keep up on things," Martin said.
Even though genetic counseling is still a relatively unknown field, Martin has seen unprecedented growth in the number of colleagues in her profession. "At the first professional meeting I attended, there were about 200 people. Now there are about 1,200 to 1,500 involved," she said.
And the only way is up, according to Martin. "The field will get to be more well-known, especially with the completion of the Human Genome Project," she said. "People want to know what they are at risk for, what they can do about it."
Cracking the Code of This Dream Job
Practitioners in this field must combine the scientific acumen and the emotional fortitude to help people cope with genetic predispositions. Like most counselors and therapists, Martin points to internships and field experience as the best litmus test for aspiring genetic counselors. She was lucky enough to work with a genetic counselor during her graduate program. But it's possible to start smaller, too. "Spend some time in a counseling setting to make sure that's what you like," she said. "Volunteer at a suicide hotline, or Planned Parenthood." She also advises students, "Taking time off [between college and graduate school] is a wise thing. I didn't, and I was burned out when I started," Martin said. Also, Martin was quite young when she entered the profession almost 15 years ago. "There I was, 25 years old with patients who were 40," she continued. "So it's a little strange. You have to learn how to deal with it."
Like most health care professionals, Martin also has paperwork to keep in precise order. "The worst part of the job is billing," she said. "Dealing with insurance companies is hard."
So, if you think you can handle the complexities of both human emotions and human wiring, crack the books, crack the code...and dream on!