On Knowledge
4. “I don’t know” is a legitimate answer. Acknowledging the limitation of your knowledge is a valuable skill. Dealing with uncertainty is a common experience in the practice of rheumatology, and it can cultivate an enriching sense of humility. Don’t lose confidence in your uncertainty, for you are in good company: The most knowledgeable clinicians, after all, are often the first to acknowledge what they don’t know. When you are stuck on a case, don’t hesitate to discuss it with your peers or mentors. One of the least expensive tests you can order in a hospital is a consultation.
On Bedside Manners
5. Connection with the patient comes first. Patients are aware of the level of caring and commitment they receive. Two types of physicians exist: The physician who is in the patient’s room because they have to be there, and the physician who is in the patient’s room because they want to be there. The patient can tell the difference immediately.
Which type of physician are you? Every extra minute you spend building trust with a patient is worthwhile. A well-developed patient-physician relationship will serve both parties well in navigating clinical challenges that may occur in the course of continuing care.
On History Gathering
6. A properly formatted history of present illness (HPI) is your most valuable diagnostic tool. The patient history remains, among all diagnostic methods and resources employed by clinicians to this day, “the most powerful and sensitive and most versatile instrument available to the physician.”2
Although a thorough history is important to elicit the facts, how one strings the facts together is a critical piece of the puzzle. Understanding which aspects of the HPI are relevant to the disease history is not a simple task, but a skill—one requiring knowledge and clinical experience.3 The knowledgeable evaluator can predict an accurate diagnosis in up to 85% of medical cases by skillfully combining an analysis of the presenting patient concern and properly sequencing all relevant prior aspects of the patient history.4-6
7. Trust, but verify. Many labs, imaging studies and biopsies are misinterpreted or misreported and then misleadingly propagated through the records. Always review the original data, and make an independent assessment—your reputation and the patient’s health depend on it.
On (Immuno) Laboratory Testing
8. Just because you can measure it doesn’t make it meaningful. Don’t hesitate to order tests that can possibly help the patient, as long as they have some useful positive or negative predictive value. And don’t order tests if the results can’t be interpreted.
9. Treat the patient, not the numbers. Immunology labs, although helpful, are seldom conclusive.
