QD98 - Triage Rheumatology Save

Hi. This is QD Clinic. I'm Jack Cush with RheumNow. QD Clinic is brought to you by RheumNow's virtual coverage of ACR twenty twenty, your ticket to a smarter, better you. Today, we're gonna discuss triage rheumatology.

I recently heard the term triage and led me to I kinda know what it is, but I wanted to look it up. And it's actually an interesting story. It goes way back to the Napoleonic Wars and whatnot. It comes from a French verb trier. Excuse me.

I'm a Brooklyn guy living in Texas with a bad capacity for Spanglish trying to pronounce a French word. And that French verb means to sort. And that's what triage means. It's meant that you sort it. Actually had its applicability in the Napoleonic Wars and again and again in World War I, where French doctors were asked to make the decision, Is this soldier, this injured soldier, likely to live, unlikely to live, or in need of immediate care that would make a difference one way or the other?

So it's about assigning degrees of urgency. It's about rationing services, and this became a really important issue for us during the COVID crisis when our clinics changed. Our ability to interact with patients changed. Face to face meetings took a dive. If you look at the, RheumNow report from today, Monday, you'll see that, a recent study shows that outpatient visits are now back up to their pre pandemic levels.

And it showed at least across the board, a lot of patients, a lot of ambulatory clinics looked at, at least a 60% drop in outpatient visits was, seen, during April and May, and it's slowly come back up. But we're still struggling with, I think, a number of changes as a result of the pandemic. The question is, are we doing any triage for our patients, or are you back to normal? During COVID, the idea of what encompassed an urgent visit was written about by me in a blog called Urgent or Not. And there, I think I defined what I thought was an urgent visit.

Red flag conditions, gout, septic arthritis, acute monarchitis. Any new acute inflammatory arthritis, especially the more polyarticular. Actually, monoarticular is quite worrisome too. Worsening of polyarthritis, fever, neurologic symptoms, or ocular symptoms that might be uveitis. Those are urgent conditions.

Maybe even more urgent, maybe emergent would be things like stridor, seizures, high fevers, new thrombotic events. And then in certain conditions, like AS, spinal trauma in someone with AS, or in myositis, someone with dysphagia, dysphonia, or rhabdo and trauma, or tea colored urine. And then lastly, someone with PSS, worsening hypertension and possible renal crisis. You know, so there are good definitions for what needs to be triaged, especially during times when you're contracting services. Is that appropriate now or not?

It's for you to decide. But is it appropriate for rheumatologists to be triaging their clinics? There's fifty five million Americans who have arthritis, but yet the four thousand nine hundred and fifty that the ACR says we have in rheumatologic services, they can't take care of those patients, and realistically, there's only about 3,200 prescribing in the trench rheumatologists in The United States, so you need to be very selective about what you do. Or, you can just take all comers and fill your schedule. I think rheumatologists have been a little too complacent in their business model designs, and said, I'll take care of everyone.

Well, that's great. There are lot of people who are not getting your services. So, would make a pitch that we actually have some triage to our clinics. The problem is triage requires effort. There are those rheumatologists often in either big practices or academic centers, where to get into rheumatology clinic, your chart has to be reviewed by the chart reviewer who's got his own set of rules about what gets in and what does not get in.

So we bring in the patients I want to see, and we deter the unmentionables so that they can go somewhere else, you know, whether that's osteoarthritis, chronic pain, fibromyalgia, CPRS, POTS. You know, there's a lot of things that rooms don't want to see, because our it goes back to triage. How likely is it that the intervention, our intervention, is going to make a difference in the outcome? So it could be that you want to be a super rheumatologist, a super room where I only see one thing. You know, I only see polymyositis patients or dermatomyositis.

That's my area of expertise, that's all I'm going to say. I think that's reasonable for some of you, but there are very few people that are doing this. The bottom line is triage could be an important part of your life and your practice, and maybe how you live even after COVID. Tune in for more QD clinics this week.