Tuesday, 20 Aug 2019


MACRA for the Overwhelmed Rheumatologist

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!


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


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.

Wine (and Food) and the Rheumatologist Attends EULAR 2016

After several months’ hiatus, I am back and writing about my recent trip to London. My past blogs centered on wine from my rheumatology-related trips and experiences. Moving forward I'm adding a culinary dimension; hence, it will be Wine, Food and the Rheumatologist. My bone fides? Well, I like to eat, that is for sure - but more than that, I like to cook. 

Morning Stiffness Madness

Rheumatologists distinguish themselves from their medical colleagues in several ways: exceptional joint exam and joint injection skills, interpretation of complex immunologic findings and cost-efficient ways of managing common musculoskeletal disorders. But what’s the one trait, skill or question that defines the acumen of the rheumatologist? Please don’t say morning stiffness.