The care of patients with rheumatic diseases requires physicians and health professionals with the experience and knowledge of complex rheumatic diseases. The collaboration of physicians, nurse practitioners, physician assistants, social workers, cognitive behavioral therapists, physical therapists, and others allows for the optimum outcomes for our patients. This month the ACR and the ARHP presidents are collaborating to describe the members of the rheumatology practice team and the roles they fill in the care of patients with rheumatic disease.
In rheumatology, there is no such thing as a Lone Ranger. Because rheumatic diseases are often complex and affect many aspects of the patient’s life, effective management requires the coordinated efforts of a diverse group of professionals. Wikipedia defines a team as a group linked in a common purpose, and notes that a team is especially appropriate for conducting tasks that are high in complexity and have independent subtasks. This definition certainly describes the rheumatology practice team, composed of several health and office professionals who work together to serve the patient’s needs. To better understand what each professional brings to the team, we would like to share the clinical rheumatology team responsibilities and why each team member enjoys rheumatology care.
The opportunity to be a patient’s doctor for an extended period of time, along with the challenges of diagnosis and the rapid development of new effective therapies, makes Dr. Borenstein happy being a rheumatologist—he would not do anything else. The rheumatologist’s role on the practice team is that of the organizer of the team that treats the patient with rheumatic disease. You never know what challenge you will see, and Dr. Borenstein likes rheumatology because of the variety of problems that await him on the other side of the examination room door. Every patient is different, even though they all have a rheumatic disease, and the selection of the ideal team for a patient is based upon their illness and the social environment necessary to offer a comprehensive program of care. As a rheumatologist, you also do not know if that patient will be with you for one visit or for decades. As team leader, the rheumatologist receives information from the other members of the team and modifies the plan to offer the best outcome for the patient.
Nurse Practitioners and Physician Assistants
To help meet the demands of an increasing patient load, rheumatology practice teams have added nurse practitioners (NPs) and physician assistants (PAs). The NP and PA evaluate patients by performing a comprehensive history and physical examination, order and interpret appropriate diagnostic tests—such as laboratory studies, X-rays, magnetic resonance images, and musculoskeletal ultrasounds—formulate a plan to manage the patient’s condition, and prescribe, order, and implement interventions and treatments in accordance with state law. They also evaluate and document patient and family progress toward attainment of expected outcomes and provide consultation to other providers to optimize the plan of care and affect system change.