One other area that has been a great dilemma is pain management. Pain is the cardinal manifestation of rheumatic disease. There is the conundrum of balancing effective, targeted pain management and the use of medications, including opioids, with undesirable side effects. Pain management was considered, but was not predominant, during my fellowship, and the role of opioids for musculoskeletal pain is limited by current science. The principle of patient self determination has to be balanced against the physician’s right and duty to practice medicine responsibly. I have had to learn to say “no” in certain circumstances.
Time Management
I never imagined that time management was going to be one of my greatest challenges. Regarding patients, I see many more patients each week than during my fellowship and have to be very efficient in my time spent with them. Asking them, “What has been bothering you the most in the past two weeks?” has proved to be a remarkably useful question to succinctly focus both their and my attention on the most important issues.
Many other things are going on concurrently during my work day, including patient calls and emails, dictation, driving to different practice sites and academic activities. I sometimes feel overwhelmed.
I received two valuable pieces of advice from one of my partners during my first week: “Don’t ever have the patient feel rushed,” and “Temper the length of your dictations.” Regarding the latter, he said that what a referring physician is primarily interested in is what the diagnosis is and what to do about it, and the rest of your dictation is usually not read.
Working closely with my staff as a team is also critical to keep flow efficient and to help establish rapport with my patients.
In terms of my understanding of the course of rheumatic diseases, it is now even clearer to me that I have to learn to accept great patience in managing them and that a “tincture of time” is frequently required to understand their course.
Maintain Balance
These perspectives and lessons learned during the beginning of my practice career have been enlightening, challenging and unexpected. I realize more fully now that my time, skills and energies have limits, and when used up in one part of my life, their absence affects other parts. These limits force me to define and redefine my professional and personal priorities, which is an unending task.
My wife and child are the most important part of my life—a fact that I must not, and will never, lose sight of.
