While the ACR prepares to publish its new guidelines for the diagnosis and management of vasculit
18 Feb 2020
Low-dose methotrexate (LD-MTX) was studied in high risk cardiac patients in the cardiac intervention trial (CIRT), but was prematurely ended for not showing a change in cardiovascular event rates. Nonetheless this trial studied the safety and adverse event rates of LD-MTX and those results are reported in the current issue of Annals of Internal Medicine.
It began as many cases do: an ill patient, in the ICU, with signs and symptoms across several body systems, yet no clear unifying diagnosis on admission. With things stabilizing, the internal medicine hospital team on which I was serving as hospitalist that week assumed care of the patient. As the case unfolded – pulmonary infiltrates that could be hemorrhagic, renal dysfunction with proteinuria – rheumatic diseases rose in the differential. When serologic studies and other data suggested GPA rather than glomerular basement membrane (GBM) disease or other possibilities such as infection, it seemed the right time to act. And that is when a game of what I call “steroid poker” began.
The House of God is probably more known of than read, with over 3 million copies sold since its release when I was a Chief Medical Resident in the era of its writing. The book itself, according to the author Samuel Schem (aka Steven Bergman, MD, DPhil), a psychiatrist and currently Professor of Humanities at NYU, is a true account of his internship, albeit laden with some liberties of fiction - and it's been quoted for generations. The House of God is cruelly funny and portrays many uncomfortable and dehumanizing aspects of medicine, including substance abuse, bawdy sex (and lots of it), sleeplessness, depression, and suicide to name a few. Taken at face value, it would seem countercultural to our current aspirations of putting patients first, #MeToo and burnout concerns. Is this book merely a humorous anachronistic rant, or a serious work of reflection meritorious of being read and pondered upon?
It’s hard work wearing a crown. The dermatologists have been dethroned as Medscape’s happiest specialty after years at the top. While studies only detail that we are the most satisfied outside of work, I argue we are the happiest working, too. With an N of 1, here are my 10 observations.
QD Clinic - Weighty Decisions in RA