Many trainees tell me they’re attracted to rheumatology because it demands becoming a complete physician. We need knowledge of the brain, eye, lung, kidney, liver, skin, bones and vascular system to be effective rheumatologists. And because our diseases are frequently multisystem diseases, rheumatologists must be the quintessential collaborators.
For more than 30 years, I’ve directed a clinic for patients with ocular inflammation. Although I’m trained as a rheumatologist and have no formal training in ophthalmology, I’ve relied heavily on ophthalmologic colleagues to forge a collaboration that seems to work for patient care.
We live in an era of dysfunctional compromise. Look at Congress, which struggles to pass a budget and in which members of one party rarely side with their peers from the opposite party.
Unfortunately, sometimes it seems we as physicians don’t do much better than our politicians. Some of us feel powerless in a system that obstructs achieving our ideals. The electronic health record, prior authorization and the challenge to provide biologics to those who lack insurance remain among the obstacles that vie for our time and make it nearly impossible to find a window within the day to discuss patient welfare with another provider. Finding common ground with a doctor from another specialty isn’t always easy. Barriers include defining whose advice is the ultimate guide for patient choice; how we are compensated for the additional time involved; and the difficulty in avoiding making the patient feel like a ping-pong ball batted between two personalities strong enough to survive medical school and postdoctoral training.