Aug. 20
I am in the clinic and a nurse comes into my room. She tells me that Mr. H is in the waiting room and hoping to be seen. He could not tolerate his medications. His knees are worse. The words feel heavy as she says them. I wonder if I have let him down. I walk into the waiting room. Mr. H tells me about his symptoms of severe nausea and vomiting after taking methotrexate, and then about his worsening knee pain. He states that he did not know how to call.
I pause.
I think of what this experience must be like for this young man, alone in doctors’ offices, having undergone multiple procedures, and still not feeling better. He is scared and wants nothing more than to be healthy and to walk comfortably again. I speak with Mr. H about his concerns, and together we develop a plan. I am confident he will return improved.
Aug. 30
I have come to appreciate that I have begun fellowship training at a time of dramatic, historic turbulence and transformative change. COVID-19 confounds the expectations for fellowship training set forth by the Accreditation Council for Graduate Medical Education.4,5 Clinical trials are on hold. Board examinations are postponed. Methods of evaluating fellows are strained. Milestones cannot be met. Yet we adapt and persevere and, hopefully, will emerge better and stronger.
Education, training and patient care in rheumatology—indeed throughout medicine—will never be the same. Our field, though, is special. We have, I think, a set of values and an identity that endure and will sustain us during the pandemic.3,5-7 It takes an unusual disposition and perspective to serve our patients.
We offer to share in the predicament of others. We seek wisdom when certainty is elusive. We cultivate patience, humanity, empathy, altruism and tolerance of uncertainty. We aspire to be knowledgeable, thoughtful, responsive, ethical and compassionate in today’s complex world. We accept realities and prepare for and adjust to tomorrow’s changes. We attempt to preserve the best of our traditions and to develop new strengths to successfully meet the future. We never lose sight of our categorical responsibility to do the right thing and to care well for our patients.
Rheumatologists are drawn to this cognitive-based specialty because of the intellectual challenges. The good rheumatologist models a scholarly, humanistic approach to medicine. But the good rheumatologist also appreciates that rheumatology at the bedside remains inherently a clinical exercise, that good medicine uses science to inform art and art to inform science. Rheumatologists love the immediacy of our specialty, the ability to understand by talking to and touching patients. Rheumatologists take special pride in knowing our refined clinical skills remain indispensable.7 For these reasons, rheumatologists perhaps are uniquely suited to play a leadership role as medicine evolves in response to COVID-19.
