Where do your patients sit? Have you noticed they don't usually sit where you expect them to? What's up with that, and is there a psychology behind one's choice of seating? This curious observation may portend the nature of the physician-patient relationship or, at the very least, impact the layout of your next clinic.
The five do's and don'ts when it comes to vaccinating your patients.
Google Images is a treasure trove of photos and drawings about medicine. The pictures of RA, though, look as if nothing happened in the last 90 years: the field stagnant, gold the gold standard, biologicals never invented, ulnar deviation rampant and joint destruction inevitable. If early recognition of inflammatory disease is at the crux of modern treatment, why show end-stage disease except as a warning?
We physicians are clearly better at defining “too sick to work” in our patients than we are for ourselves. After pondering this ill issue, I’ve come up with some wisdom, goofiness and facts.
Despite regular attendance at medical meetings and despite fulfilling regulatory requirements for our specialty, I’m not sure how much I learn that changes the way I practice medicine. So I recently persuaded a colleague to come and coach me, inviting him to observe me for a morning in clinic. This was the first time I had been observed in this way since I was a medical student. A little daunting, but after a while I largely forgot he was there. Then he gave me some feedback.
Why don't rheumatologists send their smoker patients to smoking cessation programs or use aids for cessation? Do we think it is not our problem?
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.
Patients should act as if they are the CEO of a new business. Their business is the disease they must manage. The analogies of managing a business and a disease are numerous and instructive for patients and physicians alike.
We review the available literature, with a particular focus on the recent findings in the Hopkins Lupus Cohort, regarding the clinical utility of hydroxychloroquine blood levels in helping to clarify some of the issues regarding retinopathy, how best to dose this medication, and medication adherence.
Our inner thoughts are usually negative, critical or pessimistic. Negative thinking is ubiquitous, and may be responsible for indecision or ill-choices. How to identify it and deal with it in patient care is an unsavory challenge often left undone.
It’s somewhat bizarre that a designer drug from over 65 years ago would become the cornerstone of treatment for rheumatoid arthritis in the 21st century. When Sidney Farber designed a molecule that would interfere with folate metabolism in the middle of the 20th century, he was looking for a ubiquitous antimetabolite to treat cancer. Farber was actually quite concerned with the potential side effects of a drug that competitively inhibits folate metabolism. That is part of the reason he combined the “met” for metabolism with an “x”. The x was found on poison bottles and he thought it wise to include it in the name of this agent.
I’m alot better at RA in the last 10 years than I was when I started to practice 30 years ago. RA has not changed, but tools, knowledge and treatments have progressed admirably. Decades have taught me that many aspects of RA were wrongly taught, misunderstood or not apparent when I first started in rheumatology in 1984. Here are 10 things I've learned.
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