A Day in the Life: Consults with a Rheumatology Fellow Save
Join medical resident Siobhan Deshauer, MD, as she visits three hospitals for inpatient rheumatology. Watch the video or read the partial transcript below. Siobhan Deshauer, MD, is an internal medicine resident in Toronto. Before medicine, she was a violinist, which is why her YouTube channel is called Violin MD.
Deshauer: Hey, guys. I'm Siobhan, a fifth year medical resident specializing in rheumatology. Today I'm covering the inpatient rheumatology service, which means we're seeing patients in all three hospitals in the city, so it tends to be a little bit unpredictable. It then can get pretty busy. I'm really excited to be filming today. It's been such a long time. I have got to update you guys about the exam I did. It's going to be a lot today. OK. Let's get going.
All right. While I was driving over here I got paged, and I just answered it. It's the neurology team, but at a different hospital, not the one that I just drove to, of course. And they have a patient that they are hoping we can see today. The good news is that I'm not on my own today. I actually have another resident, an internal medicine resident, who is doing their rheumatology rotation. I'm going to text Elon and get him to start working on that consult while I finish up these follow-ups and hopefully be able to get over to that other hospital soon. We'll try to be efficient today. OK.
The big update is that I wrote the rheumatology licensing exam, the written first part of it, a couple of weeks ago. And oh my gosh. I don't even know what to say about it. You study for 9 months. You do a 3-hour exam. You study so much and only a small part of is actually on the exam, but it feels good to be done. The more I think about it, the more nervous I get. Hopefully, in 4 weeks I'll find out if I passed. I just want... I just want to pass. Oh my goodness. I'm hopeful, but you never know until you get that confirmation, so yeah. Then I'm taking a couple of weeks off studying before I have to get ready for the oral exam in June.
This first patient has a history of lupus and came to the hospital with abdominal pain. She was diagnosed with appendicitis, and I really don't think this is related to her lupus. But still we're going to run some extra blood work and urine tests just to confirm that her lupus isn't active.
You may be surprised to see me writing my notes by hand, but there is actually great news because the hospital is finally transitioning to a system where everything is in the computer. I just wish it had happened earlier in my residency, because it's going to be a huge upgrade.
OK. Two more patients downstairs and hopefully [pager beeps], OK. It's also at a different hospital. Oh, guys. It's going to be a busy day.
"Oh, hi. This is Siobhan from rheumatology returning a page. I have no idea. I just got the page." OK. Luckily, that wasn't a new consult. It was the internal medicine team paging to let me know that one of our patients is being discharged home today. They just want to make sure that they are going home on the right medication and that they have a follow-up appointment, so really more just administrative work more than anything else.
The next patient that I'm seeing has myositis, inflammation in the muscle, and the reason that rheumatology is involved is because we think that she may have an autoimmune process, so her immune system is actually attacking the muscles. But she is still very much a mystery that's unraveling and so it still could be something like cancer or a side effect from a medication, or even an infection. We still have a lot of work to do. She is the one I'm the most worried about.
I go to see the patient. She is a 50 year old woman and she was previously healthy. Over the course of a month, she became progressively weaker at home until she could no longer stand from a chair without help. That's when she decided to come to the emergency department. Today, I test her muscle strength and I find that her hips and her shoulders are quite weak, but interestingly her hands, her wrists, and her feet are really strong. This is classic for an autoimmune myositis.
I'm sending off blood work to check for antibodies that can be associated with myositis. If it comes back positive, it makes it much more likely that her immune system is attacking her muscles and the next step in making the diagnosis is getting a muscle biopsy, which can take a while to get, but I'm going to see what I can do to advocate for this patient to get it faster.
I just saw the patient. She definitely needs a muscle biopsy. It will be done by interventional radiology, but it can be so hard to actually try to track them down on the phone. I'm going to try to catch them at the radiology department.
It just goes to show you like one of the biggest things I have learned in residency is you just pick up a phone or even better is actually go down, see someone in person, and you can make a big difference. The logistics are crazy in the hospital sometimes.
OK. I have just learned that it's actually not the interventional radiologists who do this at this hospital. It's the MSK radiologist, so we're going to go try to track them down.
Oh my gosh. It's like a maze down here, but I think this is the right office. I'm feeling really good about this plan. This patient is going to get a biopsy hopefully early next week, which is amazing. As an outpatient, it would be like 3 or 4 weeks at the earliest.
That took about an hour and a half longer than I expected. Geez, those follow-ups. If you need to take the time, you have to take the time, but now I feel like I'm a little bit of a rush, so let's get to the other hospital and try to keep going.
Come on. Let me out of parking. What? Please let me out. Ah, there we go. OK. At least I brought a protein shake, so I'm just going to drink this on the way. There's not really time for lunch today OK.
I'm at the second hospital, but I realized I really can't share anything about the patient I'm going to see. We're seeing a number of patients there, but there is just one that I'm worried about that I'm going to go see today. But she has such an incredibly rare diagnosis that if I share anything about her case it can be recognizable, so basically I'm not going to film this part of the day. I will catch up with you at the third hospital.
OK. Here we go at the third hospital now, the final hospital. This is where we have got three new consults and some follow-ups to see, so it's actually our busiest hospital. You'll see I'm in my N95 now. Basically I was down the emergency department, so I needed to put it on. It's just been this week that I have noticed people have started wearing surgical masks again in the hospital and then I started wearing them, but now I'm questioning, Should I still wear 95s?
Honestly, I don't know. I'm sure that you guys are going to be commenting about that. I'm not sure what the best thing to do is right now, so I'm sort of going based on risk. If there is the emergency department patients coming in, recently I'm wearing an N95 . Otherwise sometimes I'm just wearing surgical masks now. But maybe in my next video I'll say something different.