I have five direct partners who have helped me learn the ropes, including familiarizing me with our practice sites and hospitals, helping me become efficient with the mechanics of practice, introducing me to medical and administrative colleagues, and assisting me in building my patient base. They counseled me about the realities of the business of medicine, the puzzles of meeting RVU goals and the importance of achieving comfortable Press Ganey scores.
I still have a hard time calling my partners by their first names and not Doctor. It’s a hard habit to break. Learning to work with staff five days a week with some supervisory responsibility—as opposed to three half-days in the office as a fellow—has been challenging. Good humor and steady temperament have been essential.
My Patients
My most important relationship, of course, is with my patients. As a physician, I have learned that I have multiple responsibilities: diagnostician, care manager, advisor, advocate and teacher (doctor Fr.= teacher). Integral to these roles is having my patients establish their trust in me.
My patients expect me to completely “fix” their problems as quickly as possible. However, because of the nature of rheumatic diseases, I am often only able to manage the problem and not cure it. I have to accept that I cannot make patients completely better. I am constantly reminded that rheumatologists take care of complex, immunologic, multisystem diseases, and it is the comprehensive diagnostic and management skills required that had attracted me to our field.
I am also experiencing another altogether different reality in my practice. I take care of a wealth of patients with nonspecific ailments, such as fatigue, generalized pain, insomnia and emotional comorbidities. I am, at times, dumbfounded while trying to locate the source of problem: mind vs. matter? The lack of lab tests that dichotomize the problems into yes and no, which once attracted me, now amplify the uncertainty in diagnosis.
“Listen to your patient; he is telling you the diagnosis.”—Sir William Osler
That axiom is oh so true. The world of uncertainty is much larger, broader and deeper than I had expected, and learning to manage it is perhaps as endearing as the initial passion that led to my selecting rheumatology. In this dilemma, I had to develop practical care approaches, including a realization of the importance of educating patients in simple terms about the why and how of illness and what to do about it. Quality education is an essential element in achieving a successful patient experience, such as explaining why a mildly positive ANA does not always mean lupus, validating that pain is real in fibromyalgia, or even discussing immune mimicry hypothesis of autoimmunity. Feeling well informed helps patients circumvent insecurity in their suffering, establishes trust and, at least in part, is therapeutic by itself.
