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The EHR is Down! $@&#!

The advantage to patient care without the crutch of an EHR. What do you do?

Gangsin: 갱신 Korean: refresh, renew, updated

Remaining status quo requires less effort than making a change. Over the last 20+ years, I have listened to thousands of patients confide their personal stories. Some remained paralyzed in their current state of distress, fearing new situations may be worse. I was one of them, until recently. In this final blog of my trilogy on self-discovery, I reveal my new life.

Chào: (Vietnamese: Goodbye/Hello)

One of the first words I was taught by my parents was “chào”. In Vietnamese, you say chào and bow when you greet someone or when you leave as a sign of respect. In my first blog about self-discovery, I detailed the burnout and why I left clinical practice. In this second blog of the trilogy, I wanted to share encounters with patients as I told them goodbye. While I received great advice when I started practice, no one ever talks about how hard it is to leave.

Karoshi - {Japanese  過労死: Death by Being Overworked}

Over the last few decades, Japanese workers were collapsing dead at their desks or committing suicide due to the high stress stemming from their jobs; Japan coined this phenomenon, “Karoshi.” In 2021, the World Health Organization and International Labour Organization issued a warning:  working 55+ hours a week is a serious health hazard and increases the risk for death from heart disease and stroke. But since the pandemic, I see many colleagues working hard at the expense of their health, family life, mental and emotional well-being. I never thought I would be burned out because I had passion for my job.

Teaching and Academic Burnout

RheumNow recently highlighted a publication that reported about a third of physicians in academia intend to leave. To our colleagues in non-academic situations, this may seem incredibly high. I think an important contributor to the intention to leave academics is that something that used to be a benefit has now become a challenge: namely, teaching.

Choice Overload (and the Way Out)

I recently overheard a very good practicing rheumatologist complain, “why do I need yet another drug for psoriatic arthritis? I have more treatment choices than I have actual PsA patients who need a new or better drug”.

Advancing PMR

Even though polymyalgia rheumatica is not perceived by many physicians as a severe diagnosis, its diagnosis and management actually propose significant challenges. I'd like to talk about those challenges, and what directions our path forward can include to advance our understanding and improve the treatment of patients who have PMR.

Unpopular opinion: spinach can be bad for you

PMR might be one of the most rewarding diagnoses to make in real practice: the patient comes to you in severe debilitating pain, and you prescribe steroids, giving them their lives back! As much as this impressive response makes your intervention appear almost magical, there is the often-forgotten story about the implications of such a diagnosis and treatment on patients' daily lives. 

IL-6 Inhibitors in PMR: Give early or late?

It's exciting to be able to have this conversation because it's only in the past year that we have an approved non-corticosteroid therapy for PMR that's been shown to be effective in a well done clinical trial.

What Happened to the Pharma Reps?

Dr. Jack Cush weighs in on changes in pharmaceutical "detailing" with suggestions for the future.

ICYMI: A Shortage of Trust

I wanted to complain about patients who complain, but guilt and common sense took over. I intended to declare the problem to primarily belong to the doctor, rather than the patient. To me, the solution to the patient’s consternation should begin and end with the source: me (you). My introspection, reasonings, and commandments were fine, but I kept running into the enigma of “Trust” – which can either be a speed-bump or chasm in our physician-patient relationships.

A Card-Carrying Optimist

I may be a snarky, opinionated curmudgeon, but I'm an optimist when and where it counts. And I think you should join me.