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As a first-year internal medicine resident, I find myself consulting rheumatologists for just about every mystery patient in our hospital. Like many residents, I was initially intimidated by the complexity of this elusive field. At first glance, diagnosis and management seem completely inaccessible to a first-year resident. But several rheumatology consults later, I can confidently say that understanding the basics is certainly worth the time.
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September 2018Diagnosis without Knowledge
In the era of cost-effective medicine, we are taught to be judicious when ordering labs and imaging. To do so, we must understand how each test will help us care for our patients.
When it comes to rheumatic disease, however, the average resident lacks such understanding. We send off a battery of immunologic tests with a vague idea of how these results will guide our management. How much do we really care about a positive anti-nuclear antibody (ANA)? How often do we track complement levels, and why are we doing it in the first place? We turn to rheumatologists to guide us every step of the way.