Tuesday, 17 Sep 2019

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QD Video - Bug Bite Arthralgias

QD Videos from RheumNow.Live . "What do I have doc"? from a man with post bug bite oligoarthralgias. "Not all symptoms merit a diagnosis; some are just evidence of human imperfection".

Rheumatologists' Comments

I suspect that unrealistic expectations on the part of the patient and/or rheumatologist regarding diagnosis and/or treatment of real but nebulous symptoms in the setting of uncertainty often results in "attributional bias" and a diagnostic "label" that satisfies all parties involved (I borrow this term from Dr. Norman Hadler who uses the terminology "attributional ideation" in his writings.) Your thoughts are well taken that in the face of uncertainty, as time and circumstances allow, watchful waiting, conservative or symptomatic treatment, and appropriate diagnostic efforts are options often overlooked in an effort to placate the "customer" as well as meet the the coding demands of the EHR and payor. Worse yet are the demands we place on ourselves for perfection, efficiency and time constraints. Uncertainty is inherent in Rheumatology (up to a point). Just make sure the patient is included in any watchful waiting so they will return for followup and not get misdiagnosed prematurely by a differet provider with "tunnel vision" (as in neuropathy, Lyme disease, SLE, carpal tunnel syndrome, MS, FMS,etc!)

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