Tuesday, 20 Aug 2019

Blog

Best of 2018: 5 Mistakes When Diagnosing Adult-Onset Still’s Disease

Adult-onset Still's presents an interesting and diagnostic challenge when encountered. Here are 5 tips to improve your diagnostic acumen for this febrile disorder.

Best of 2018: The Millennial Doctor- Mighty or Mediocre?

A 3rd year medical student started his rotation with me this past week and the rotation was a challenge for us both.

Best of 2018: Dealing with Drug Reps - Dead or Alive

Several years ago, long before promotional lectures, I traveled for a series of lectures. I flew north for 4 days and 4 lectures, 2 at major university programs and 2 dinner lectures to local rheumatologists.

The first lecture went well but the weather turned bad, with a snow storm in the overnight forecast.  Hence my host, a local drug rep, suggested we drive at night to beat the snow and get to the next city for the 10 am University lecture the following morning.

The one-hour drive felt like a week in Cleveland. 

Best of 2018: Death of the Dinner Meeting

Many years ago, rheumatologists would assemble with lunar regularity to discuss cases, journal articles or listen to a great visiting speaker or le

Best of 2018: The Delayed Diagnosis of Spondyloarthritis

You see them from the corner of your eye, standing with a kyphosis in the waiting room. They are filling out their paperwork, standing up because sitting is just not pleasant. You are the rheumatologist with an  interest in ankylosing spondylitis (AS) and spondyloarthritis, so more likely than not, the patient with the bent spine is going to be your next new patient. In the back of your mind you are hoping that they are not so far along so that the therapy you may prescribe can make a difference in their life.

Advice for Young Rheumatologists

You may not want my advice, but I’m going to give it to you anyway. 

Pain: Objectifying a Subjective Symptom

My typically pleasant 76 year old male was livid when I walked into the exam room. He was pacing back and forth with furrowed eyebrows.

Rheumatology Dead Word Cemetery 2019

I recently heard of a secondary school assignment wherein students were challenged to “bury” a word that was no longer useful or appropriate. Their exercise has now evolved into an unofficial RheumNow task force to retire diagnostic terms that have grown into misuse in rheumatology and medicine. How did we decide which words should perish? And by what criteria? Who has the final say?

The "No Show" Problem

As the healthcare landscape continues to change, “no show” rates will be an important factor for clinical practice. Implementing even one or two of the following proposed changes may help improve your no show rates.

The Medical History – Pitfalls and Preferences

By recognizing the limitations of memory and patient recall, I tend to focus historic elements that have high predictive value and avoid time consuming worm-holes in history-taking that have low predictive value. This leaves me with more time to listen to the patient.

Prescription Drugs and the Effect on Access to Biosimilars in the US

The word “access” is thrown around a lot these days, particularly regarding health care and specifically, prescription medications. Access to medications essentially revolves around two things: availability and affordability. Immediately, pharmaceutical manufacturers come to mind, as they are responsible for production and setting the list price. However, ultimate availability and affordability of medications is shared with another entity. The final arbiter of access is the Pharmacy Benefit Manager. Their power resides in the fact that they control the formulary and determine the “preferred drugs” list. How does this relate to the uptake of biosimilars?

Best of 2017: Across the Table: Cush & Erkan on Antiphospholipid Syndrome

DErkan

The antiphospholipid syndrome (APS) is a common disorder affecting patients with and without autoimmune disease. Despite wider recognition of APS among physicians as well as the expanding research collaborations, many clinical questions are still encountered in clinical practice, which require further evidence-based studies. In this “Across the Table” edition, Drs. Cush and Erkan discuss some of these APS-related questions. Our guest expert, Dr. Doruk Erkan offers up his approach to diagnosis and management of APS.