War on RA - Part 2: It's All About You-YouTube Save

This is a great insightful and provocative video Jack. Another change I would advocate for is that rheumatologists be more quantitative in their assessements of patients with RA, SLE and other rhuematic diseases. Whatever problems we may have with EMRs, they do allow for better tracking of quantitative clinical and lab data- important in T2T strategies. Also we need to be more selectively quantitative in our assessment of patient adherence to therapies by measuring blood levels when indicated. For instance in a patient not doing as well as one would like on MTX 15 mg weekly, rather than jumping immediately to a biologic why not measure MTX polyglutamate level? If low then check if the patient is really taking it appropriately and consider switching to SC at the same or a higher dose. In some instances, this would help the patient and would reduce the use of expensive and possibly unnecessary biologic therapies. Just my opinion.

Jack-I appreciate and agree with your impassioned presentation in RA2. The word idealistic comes to mind (we all can't be a Ghandi), Your entreaties remind me of the Old Testament Judges and Prophets warning the royal and clerical leadership of the consequences for not following Mosaic law and covenants and their unwise political choices. I do not not think much will change as long as the current "one-on-one" patient care approach characteristic of a small business prevails. A team approach to patient care directed by the physician that fully engages and empowers the patient to participate is needed to meet the clinical demands of healthcare and address many of the issues you raise regarding evidence based disease measurement, management and outcome. The patient must be involved in their care and decision making. Even the most conscientious clinician soon gets "ground down" by the relentless demands for productivity, efficiency and "patient satisfaction". Ultimately, short cuts develop that limit intellectual honesty and critical thinking. (part 1)

(part 2) Some very gifted colleagues are able to develop well oiled clinical machines that maximize productivity and address the ever changing administrative and regulatory demands regarding efficacy, accountability and credibility. Such "machines" are not fun for either the patient or the caring physician. A physician running a small business morphs into a businessman practicing medicine. We need one unified national template for rheumatologic disease oriented patient care regarding diagnostic, therapeutic, clinical monitoring and outcomes, functionality, quality of life, AE's and other evidence based parameters you discuss. Its time for 21st Century medical care. David Knapp, (retired rheumatologist)