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ICYMI: Steroid Poker

It began as many cases do: an ill patient, in the ICU, with signs and symptoms across several body systems, yet no clear unifying diagnosis on admission. With things stabilizing, the internal medicine hospital team on which I was serving as hospitalist that week assumed care of the patient. As the case unfolded – pulmonary infiltrates that could be hemorrhagic, renal dysfunction with proteinuria – rheumatic diseases rose in the differential. When serologic studies and other data suggested GPA rather than glomerular basement membrane (GBM) disease or other possibilities such as infection, it seemed the right time to act. And that is when a game of what I call “steroid poker” began.

ICYMI: Drug Safety Risk Communication- The 800 lb Gorilla Approach

Discussions on drug safety can be as treacherous as quicksand for the patient and physician. What the physician knows and what the patient perceives may not be in sync.

Three Healthcare Hashtags You Should Follow 

I've sent more than 2,000 tweets since joining Twitter in July 2010. Even better, I've read (and sometimes shared) thousands of other educational, informative and sometimes humorous tweets from fellow rheumatologists, physicians, healthcare providers and others around the world. While following individuals and organizations relevant to you is important, so is following hashtags. Here are three I recommend.

Consults in Cars

In this episode of Dialing for Doctors (aka, Tales of Telehell), we consider a growing subset of telehealth seekers connecting from their cars. This has happened several times and it always catches me surprise. While I've had "live" televideo visits with patients walking the dog, waking up in bed, and from the waiting room of another doctor's office, consults in cars is about the nuttiest. What is the patient's role in telehealth?

Best of 2020: Wisdom for New Rheumatology Fellows

Congratulations on choosing the greatest profession, one equally dedicated to both science and patient care. You are now part of a guild that will support you and anticipate your success. Rheumatology needs you to be a big thinking, futuristic problem-solving practitioner who will lead and learn, research and teach. Here are my words of wisdom for aspiring MSK phenoms.

Best of 2020: Steroid Poker

It began as many cases do: an ill patient, in the ICU, with signs and symptoms across several body systems, yet no clear unifying diagnosis on admission. With things stabilizing, the internal medicine hospital team on which I was serving as hospitalist that week assumed care of the patient. As the case unfolded – pulmonary infiltrates that could be hemorrhagic, renal dysfunction with proteinuria – rheumatic diseases rose in the differential. When serologic studies and other data suggested GPA rather than glomerular basement membrane (GBM) disease or other possibilities such as infection, it seemed the right time to act. And that is when a game of what I call “steroid poker” began.

Telemedicine: What's Changed and What Needs to be Addressed?

Along with our patients, we've spent the last several months adapting to telemedicine. Following is an update on legislative changes and uncertainties, a look at the care gap that may still exist, and examining the trajectory of telemedicine after the initial rapid growth spurred by COVID-19.

Wisdom for New Rheumatology Fellows

Congratulations on choosing the greatest profession, one equally dedicated to both science and patient care. You are now part of a guild that will support you and anticipate your success. Rheumatology needs you to be a big thinking, futuristic problem-solving practitioner who will lead and learn, research and teach. Here are my words of wisdom for aspiring MSK phenoms.

ICYMI: Telemedicine Bloopers and Successes

At my COVID home command center, I feel pretty prepared for everything. From here, I can run my practice, manage and home-school 3 children and keep the family afloat.  I have 2 computers: one for telemedicine/business meetings and one for e-learning lessons/school updates that teachers and school administrators email me throughout the day for my children.  As a no-nonsense, organized mom and doctor, I felt ready to handle any issues that would arise. 

Urgent or Not

Our practice standards have been flipped. The physician’s best clinical tool has become the webcam or telephone. The nagging question is: “who needs to be seen in clinic or in the hospital with a F2F evaluation?” It basically boils down to urgency.

Staying Abreast of COVID-19

Dealing with unknowns is both difficult and frustrating, as the answer is often not within our reach. The current pandemic has created a tidal wave of unknowns, scaring patients and putting physicians in a difficult spot.
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