It started with an inhaler.
Like many of you, I am a rheumatologist. And like you, I see some patients more often their own primary care provider. This is so often the case that I have gradually devolved into their backup, all-purpose doctor. I am the doc they notify when they get hospitalized for pneumonia or if they’re trying to decide whether to go ahead with the hip replacement they were told they need.
From the patient’s perspective, I can understand the confusion. It must be difficult for them to understand why I seem keenly interested in some problems, but not others. After all, because I am the physician ordering the urinalysis, I must be the right doctor to approach about their urinary tract infection or their kidney stones.
Thus, I found myself trying to figure out why my patient was short of breath. In retrospect, the complaint was not new. In my defense, when a patient meets you because of digital ischemia caused by a medium-vessel vasculitis, his ability to run up a flight of stairs seems a little less interesting. Over the years, however, as his rheumatic disease improved, dyspnea gradually worked its way up his problem list until it was the only issue left.