RheumNow Podcast – Why Do We Love Rheumatology Fellows? (8.7.20) Save

Jack Cush, MD

Aug 06, 2020 8:04 pm

Dr. Jack Cush reviews why we all love our rheumatology fellows and our best advice for them stemming from these articles:

We have great and endless hope for all our fellows, especially the newbies. Here are some sage pearls of advice from my friends, your mentors and colleagues in rheumatology.

Dr. Sterling West says be humble, learn, be an advocate, don’t get frustrated and be an advocate for your patients. He states ” My hope for each of you is that at the end of your career you can look back and say “I was an excellent rheumatologist."
Dr. Eric Ruderman- “Start every visit by asking the patient why they are there and what they hope to get out of the visit. If you don’t, you risk the possibility of not addressing their primary concern..”
Dr. Jonathan Kay “The most important thing to learn during the first year of fellowship is how to become comfortable with uncertainty. Many of our patients present initially with incomplete manifestations of a disease process. ….. Time is an important component of the diagnostic process in rheumatology.”
Dr. Jeff Sparks said “Sometimes the best option is to admit you do not know and to watch and wait.”
Dr. Stephen Paget “Never treat a test; always treat a person.” “Only order laboratory tests if they will change the diagnosis, prognosis or therapy. Always ask yourself, even with the least expensive test, do I really need this? Don’t treat the chart. “ Knee Jerk practices may be efficient but are usually wrong and wasteful.
Dr. Hani El-Gabalawy “Think about research carefully. Is your fellow’s research project(s) aimed at making you a well-rounded clinician, or is this a key step towards a career as an investigator? If it is the latter, are you prepared to pay your dues down the road? That means not defaulting to clinical practice at the first sign of research failure, something that will inevitably happen as an early career researcher.”
Dr. Bonnie Bermas “If you see a four legged animal with black and white stripes galloping towards you, it’s probably a horse wearing a zebra costume....”
Dr. Michael Holers “Learn today’s state of the art treatment but always consider how we could improve that in the future. Rheumatology is an evolving discipline that is rapidly changing with new scientific methods and insights, which makes it exciting but ever challenging.”
Dr. Artie Kavanaugh “You are in fellowship to learn... NOW is the time to push those that are instructing you and teaching you... the best way is to ask questions... "Why that dose of prednisone...”. And push them to know the source. Is it data? Some classic article from the 80's that most people forgot about? Or new material that only that faculty member was privy to? Or was it their experience.”

Cushisms:

Think Fibromyalgia first.
Three things the patient needs from you at every visit – Hope, Goals and Rules
“Success is born of bold choices, grand mistakes and perseverance.”
What’s your ONE thing? Dr. Dan Lovell - “Your career will be so enriched if you find that “one thing” to focus your career on. But choose this ONE thing because working on it, and making progress in this area, is compelling and important to you - it eats at you, if you do not address it.”
“No man is an island”. Quickly bond, affiliate and partner/conspire with your fellow fellows, faculty and division members to learn, research, write and play together. There’s power in numbers; be sure to cash in. Dr. Elaine Husni - “Be a sponge. Staying engaged in conversations, ask questions, and remember the verbal and non-verbal communication.”
"Idealism and cynicism are easy. It's negotiating the in-between that's difficult, interesting and worthwhile".
Getting to certainty (Black and white) is hard

"It's supposed to be hard.

If it wasn't hard, everyone would do it.

The hard... is what makes it great."

- Jimmie Dugan from League of Their Own