Dealing with Drug Reps - Dead or Alive

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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. 

Across the Table: Cush & Erkan on Antiphospholipid Syndrome (Best of 2017)

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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.

Stop Calling Me That

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This rant is addressed to the Internet, all worldly publications, the ACR/ARHP, and our good friends at Elsinore Brewery. For the love of God. PLEASE stop calling nurse practitioners (NPs) and physician assistants (PAs) "Non-Physician Providers". And do not call us "midlevels". Do not call us "physician extenders". The collective proper nosology is Advanced Practice Providers  (Acronym of the Day: APPs).

Creaky Joints Nails New Patient Pregnancy and Family Planning Guidelines

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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. 

ACR 2017 Highlights: RA, SpA, PsA, OA, Lupus and More

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The quality of the meeting was on par with the host city, with extensive data presented on a range of topics, from social media to drug safety. The organization committee did a great job and I got the feeling that most people felt the congress was user friendly given the magnitude of the event. During this year’s meeting, I had the privilege of working with the RheumNow team, which gave me the opportunity to hone my social media skills and get my Twitter game on. After reviewing plenty of posters and going to numerous presentations, here are my top take home messages as classified by disease state.

Across the Table: Cush & Erkan on Antiphospholipid Syndrome

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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.

Online Reviews - of Burritos and Doctors

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A new patient came in today; he noted that he made an appointment with me after reading a favorable online review on YELP about our practice. 

Ten Things to Do At Every Visit

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Busy days, overbooked patients and EMR overloads will certainly derail your day, especially if you don’t have a system to optimize efficiency.  However, in your harried efforts you may overlook several simple, smart, if not crucial, tasks while seeing your next patient.

The Story Teller

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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. 

The ONE Thing

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Rheumatologist's Vacation Checklist

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Nearly half of all available vacation days go unused and over 40% of Americans failed to use any vacation days in 2015. Common sense says that taking more time off (not less) is likely to lead to increased work productivity. Your next vacation is essential to building a better you. Here are some tips to insure you get the most from your time off.

The Retiring Rheumatologist

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Just last week, I went to a doctor’s retirement party.  It was festive, with honors and ribbing for the lucky one, but there was an asterisk to his milestone. Retirement was not anticipated or planned for. What is your retirement plan?

Lipstick Rheumatology

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A 25 year-old female recently diagnosed with seronegative rheumatoid arthritis was started on a TNF inhibitor. She came in for a follow-up visit and noted that her toenails were brittle and discolored when she removed her nail polish recently.

The Negotiator

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This is going to be my third visit with this patient and I’m not looking forward to it.

In the first two, I discovered how sick she was and how, despite my handouts, efforts, insights and words, my educated medical expertise was totally wasted.

The Pain of Funerals and Suicides

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