Steroid Poker

Save

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

Save

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

Save

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

Save

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

Save

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 

Save

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

Save

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.

Improving the ACR – Big Meeting Experience

Save

Our experts say you should: Plan the night before, use the ACR meeting App, work in groups, be involved in social media and, have fun! What's your advice on how to best attend the ACR meeting?

Rheum For Interpretation: Three Tips To Apply RCTs To Your Clinical Practice

Save

At the 2019 meeting, almost 500 presentations discussed new randomized controlled trials. We are lucky to have so much research activity in our field, but applying an RCT to your daily practice can be challenging. Here are three tips to supercharge your critical appraisal!

A Review of the Review Course + How to Make the Information Stick

Save

I have been attending the ACR Review Course for more than a decade, and it seems every year it gets better and better. Contrary to what most people think, this is not a board review course; it is more of a review of the latest research delivered by experts condensing rheumatology in eight hours.

When Classification And Diagnosis Diverge

Save

Few rheumatologic diseases have diagnostic criteria, so clinicians often rely on classification criteria to diagnose patients in clinic. Because classification criteria were not designed to be used for these purposes, they have important limitations.

Should we all be Tweetiatricians?

Save

The evidence base is currently lacking on whether the use of social media can improve patient outcomes. The reality is that individual doctors and medical organizations have to consciously decide if, why and how to use the various social media platforms.