Sasha D just doesn’t like me. I’ve seen her four times in the clinic, and each visit was a tense battle of misunderstandings, with both of us leaving dissatisfied or worse. The failing wasn’t in the diagnosis, but rather the malalignment of our goals and inability to listen. Despite my efforts, my words, the diagnoses and treatment suggestions haven’t been well received.
Recently, I was invited to apply for an open seat on the American Board of Internal Medicine (ABIM), the large organization that certifies physicians in the United States. Part of the process is to write a personal statement on my views of the ABIM mission and what I would like to accomplish.
I’m a firm believer that your desk space is a window to your soul, if not your neuroses.
My first year fellow and colleague kept his desk meticulously sterile. It was so sparsely decorated and clean, he could be the poster child for minimalism. This was in drastic contrast to our program director, who had papers and books strewn about and multiple half-filled coffee cups surrounding his desk. His chair was typically found in the middle of the room with his white coat thrown about like a kindergartener’s art project.
Here are my observations from the natural habitats and home-base of rheumatologists.
A 3rd year medical student started his rotation with me this past week and the rotation was a challenge for us both.
Several years ago, long before promotional lectures, I traveled for a series of lectures. I flew north for 4 days and 4 lectures, 2 at major university programs and 2 dinner lectures to local rheumatologists.
The first lecture went well but the weather turned bad, with a snow storm in the overnight forecast. Hence my host, a local drug rep, suggested we drive at night to beat the snow and get to the next city for the 10 am University lecture the following morning.
The one-hour drive felt like a week in Cleveland.
“It’s unbelievable how much you don’t know about the game you’ve been playing all your life.” - Mickey Mantle.
What I know and learned is often the subject of blogs on RheumNow. Yet, I’ve always been challenged and irked by what I don’t know.
Angie is my last patient before lunch. I've known her since her RA diagnosis at age 17 years. And for the last 7 years, she’s matured into a fabulous young woman who has adeptly grown her professional life, her dating life and developed her independence, despite her severely active rheumatoid arthritis. But today I see she has a troubled and anxious look as I greet her.
Almost everyone gets their education about drug-related infection risk from television ads. Rheumatologists should know what the real risks are and educate their patients that they have a higher than normal rate of nonserious infections. But the infection risk is way more related to inflammation than any specific drug risk.
The antiphospholipid syndrome (APS) is a common disorder affecting patients with and without autoimmune disease. Despite wider recognition of APS among physicians as well as the expanding research collaborations, many clinical questions are still encountered in clinical practice, which require further evidence-based studies. In this “Across the Table” edition, Drs. Cush and Erkan discuss some of these APS-related questions. Our guest expert, Dr. Doruk Erkan offers up his approach to diagnosis and management of APS.
Patients and physicians are riddled with misconceptions when pregnancy is concerned. As construed by Dr. Jack Cush, most rheumatologists treat pregnancy like a cancer and avoid the gravid patient, deferring to obstetricians who do not have training in rheumatology to manage the rheumatic condition as well as the pregnancy.
I recently had a follow up with an SLE patient who wanted to discuss sun protection options since moving to Dallas, where we have 232 days of sunshine yearly. Sun protection is important for our patients. As rheumatologists, we have an obligation to go beyond 'avoid the sun or wear sunscreen when you're out' platitudes.
