Tuesday, 07 Apr 2020


It's the engine that kills ya’, not the caboose

This past weekend I was fortunate to lecture at the Harvard Advances in Rheumatology Course, where I reviewed the safety issues surrounding the use of biologic therapies. In discussing infections, cancer, cardiovascular events, etc., it became very clear to me that these problems, while worrisome, are often escalated in their importance – all at the expense of what is most dangerous: RA itself.

Florida Society of Rheumatology Annual Report

Through educational, administrative and legislative efforts, FSR works for the betterment of rheumatology practices and patients in Florida. Here's how.

EULAR 2016: Name that Country Part II

Like the EULAR Congress of 2010, the 2016 version was in the giant ExCel center out in the Docklands area. The meeting rooms are cavernous, big as some basketball stadiums. The ExCel is so big that it is served by two stations of the DLR railroad and it is probably long enough to function as a runway with planes that fly overhead on the way to London City Airport. Ed Sullivan would have called the ExCel “really, really big.” Donald Trump would say it is “yuge.”

EULAR 2016: Name that Country - Part I

When I was just a lad in the 1950s, I used to enjoy a television quiz show called “Name that Tune.” This popular show, which was hosted by an amiable singer and comedian named George DeWitt, had a premise that was simple but appealing. The studio orchestra would start playing the notes of a song and the two contestants would compete to see who could identify the song first, running across the stage “to ring a bell and name that tune.”

Go Ahead, Jump!

You write the prescription, hand it to the patient and explain why it’s needed, how to take it and what the most common or most dangerous side effects might be. Comprehensive, reasonable, and professional. Certainly the patient should fill the prescription and start the drug.

Eat the Frog

Surely you've heard the phrase “eat the frog first”.

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

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.