For Residents, Mystery Patients Often Require Rheumatologist Advice

Second, rheumatic disease remains shrouded in mystery. As residents, we tend to feel comfortable when we know the pathophysiology behind the disease we treat. The science makes us feel safe that the benefit of medical intervention outweighs the harm. Rheumatology, however, requires us to remain open to the possibility that management may not be clean-cut, and that each patient requires an individualized approach. Residents in rheumatology must accept a degree of unknown to a greater extent than in other subspecialties.

Third, treatment requires careful consideration. Starting someone on long-term steroids, biologics or pain medications can be scary for many reasons—not only do the medications come with significant adverse effects, they also may come with a high price tag. Residents must consider what may be cost-prohibitive to the patient, and then appropriately adapt the treatment plan in conjunction with the rheumatologist.

Personal Growth & Patient Support

These challenges also demonstrate how rheumatology exemplifies the art of medicine. If only as an intellectual exercise, navigating these muddy waters helps us grow as physicians and advocates for our patients.

Supporting a patient through uncertainty, setting appropriate expectations for progress and presenting the risks and benefits of an intervention are all important skills when counseling patients in all disease states. We also must explain this information in a manner that makes the patient feel comfortable participating in their care and asking questions as they arise. In other words, rheumatology requires physicians to build a strong therapeutic alliance with their patients.

Gain Awareness Now

I’ve compiled a list of resources to help the average resident feel more comfortable diagnosing and treating rheumatic disease (see sidebar, left). With more awareness, we can learn to ask the right questions and reduce delay to diagnosis for these vulnerable patients.

Veena S. Katikineni, MD, is an internal medicine resident at Inova Fairfax Hospital, Falls Church, Va.