Friday, 15 Dec 2017

Blog

My Nurse Practitioner

My NP is not only a great nurse, counselor, rheumatologist, complex disease manager, joint injector, diabetes expert, clinic leader, mother, wife, and friend – she’s the go to person if you’re a patient, coworker, colleague, cousin or neighbor. She is one of few great partnerships in my entire career. To go to battle with a NP at my side gives me a tremendous daily advantage.

The Purse Exam: a Forgotten Part of the Physical

Should you assess your patients' “purse-onality? The purse exam is an important part of the physical that can help make the diagnosis and improve patient outcomes. I often wonder if downsizing the purse should be part of the T2T (treat to target) initiative.

MACRA for the Overwhelmed Rheumatologist

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You are in good company if you find the alphabet soup of rules and regulations impacting your practice a bit overwhelming. MU, ICD10, MOC, VBM, MIPS, APM, PQRS, ACO, SGR...it’s enough to trigger fantasies of early retirement among even young rheumatologists. But don’t despair!

MONEYBALL

The movie Moneyball is a David versus Goliath tale with the A’s (David) struggling to compete with Goliath teams like the Yankees. The movie pits hunch-driven “expertise” (convention) against a mathematic approach to decision making (Moneyball). Would you trust a big Whopper computer printout of next best drug(s) to give to Mrs. Hawking who has psoriatic arthritis and needs to start a DMARD? I believe most of you would huff and scoff at a formulaic or number-driven approach.

Knee Replacement and the Physical Terrorist

Experience is a great teacher. My experience with knee replacement surgery taught me the pivotal importance of the physical therapist in individual outcomes.

Piece of My Mind

You know so much, and they have too much to learn, but limited time and few opportunities make it difficult to share information and fill that gap - especially in a way that will “stick” and be meaningful to the patient. When tempted to give patients 'a piece of my mind', here are some things to consider.

Polymyalgia Rheumatica: An Interval Look at Management Questions

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Despite an often fairly characteristic pattern of signs and symptoms, there are significant diagnostic challenges with polymyalgia rheumatica. The reason is that similar clinical features can be also observed in other diseases mimicking PMR, including infectious and malignancies, elderly-onset rheumatoid arthritis, giant cell arteritis, chondrocalcinosis or myositis, to mention some of the most important differential diagnoses.  

Time for a Paradigm Change in Rheumatoid Arthritis

How many clues are needed for a rheumatologist to know something is wrong with the therapeutic soup he/she is trying to concoct?  One patient's tale leads to rethinking the RA treatment paradigm.

TIPS for Arthritis Travelers

Travel can be challenging for arthritis patients. Here are some useful tips to travel smoothly and pain free.

The Brooklyn HAQ

The Health Assessment Questionnaire is a utilitarian outcome measure, often used in clinical trials and daily practice. Unless you’re still prescribing penacillamine, never attended an ACR meeting, and never read an RA clinical trial, you’re quite familiar with the HAQ and its use in practice. So, surely you’ve heard of the “Brooklyn HAQ”?

I Got a Hug Today

It was at the end of the visit with the patient I've only seen three or four times for her osteoarthritis, carpal tunnel syndrome and back pain. 

Take the Patient's Call

I recognized the tone in his voice. I recognized the clipped words and the unmistakable undertone of bother and dismay. I recognized them because I have had the same tone, the same clipped speech and latent frustration in my voice: and now I was on the receiving end of this undercurrent of impatience. It took my recent stint as a patient to make me realize how important the call from the patient can be.