Friday, 03 Apr 2020


Some Good Things, During the Time of COVID-19

It is not hyperbole to acknowledge that the COVID-19 pandemic has changed the world, inflicting pain and suffering to many, and inconvenience to all. As everyone struggles to make it through these difficult times, it might be worth pointing out some small silver linings that have emerged despite this pernicious dark cloud.

Telemedicine Bloopers and Successes

At my COVID home command center, I feel pretty prepared for everything.

Staying Abreast of COVID-19

Dealing with unknowns is both difficult and frustrating, as the answer is often not within our reach. The current pandemic has created a tidal wave of unknowns, scaring patients and putting physicians in a difficult spot.

Goodwill Wednesday

Business as usual, Wednesday morning, as I quickly stop at 7-Eleven for my morning coffee and it all begins. A nice stranger holds the door open for me; I reach for a carton of milk for someone unable to; the cashier skips the 2 cents on a $2.02 bill (with a smile). What transpired in a quick five minutes was a series of random, unrelated, unprovoked acts of kindness. Blatant politeness, sincere smiles, compliments between strangers and lots of open doors. This made me think.

ACR20 Pearls Part 3: Pragmatic Applications for Managing Vasculitis

While the ACR prepares to publish its new guidelines for the diagnosis and management of vasculitis in the Spring of 2020, Dr.

Steroid Poker

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.

Best of 2019 - The House of God After 40 Years: A Rheumatologist's Reflection

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?

Best of 2019 - Why Rheumatologists are the Happiest

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.

Millennial Doctors: Digital natives and the death of medicine as we know it

Millennial physicians comprise a wider, diverse population compared to prior generations, including an ever-increasing female physician community. It is estimated that by 2025, 75% of the work force will be millennials.1 This generation grew up in an era of participation trophies and structured childhood schedules, all while watching their predecessors sacrifice work/life balance due to persistent slashing of reimbursement. All of this sets the tone for change.

Tips from a HomeRheum Mom

At the recent ACR 2019 meeting, I met some incredible women who shared with me their struggles, sacrifices and success when it comes to balancing a career and family while still retaining their sense of self. Many of you know I am a mother to 3 children ages 15, 12 and 9. Life can be challenging, especially since my husband has a busy practice, too. So how do you advance your career and still raise a family? Here are five lessons I've learned.

Pearls Part 2: Common Sense Rheumatology 

We live in an era where you need evidence in order to believe, but life’s experiences should not be discounted even if we do not have the statistics to support them…yet. In Part 2 of my annual meeting Pearls Trilogy, I present ten tips and observations shared by Dr. Sterling West from his session, "Rheumatology Top Secrets & Pearls".

2021 E/M Coding Update

I had the pleasure of attending the CSRO legislative update while at #ACR19 and wanted to shed some light on one hot topic, the E/M coding from CMS and the 2021 update.