Success & Challenges of Multidisciplinary Rheumatology Clinics

Dr. Friedman (left) & Dr. Desmarais

We have all been there when a patient with a systemic autoimmune disease needs sudden coordination of care. Your patient with Behçet’s disease nonchalantly mentions he hasn’t been able to see out of his right eye for two days. The spouse of one of your patients with sarcoidosis writes to you on the patient portal to tell you that your patient can’t move his right arm or right leg very well. Your scleroderma patient with known lung disease is suddenly short of breath. These patients have a talent for coming in on Friday afternoon and not realizing how serious the problem is, and you are left to troubleshoot with any colleague still answering their pager.

Multidisciplinary clinics grew out of the need to address these complicated patients. At best, multidisciplinary clinics provide streamlined expert care from providers who respect each other and work collaboratively. At worst, one provider pontificates over another specialist who may be younger or at an earlier stage in their career. But how do we get there, and how do we get it right?

The Oregon Health & Science University (OHSU) Experience

What exactly makes a multidisciplinary clinic? Shared space, shared appointments or just a shared cohort of patients about whom communication is a regular part of care? We present here our experience with multidisciplinary rheumatology clinics currently operating at OHSU, Portland.

Some clinics share space, and others are physically separated, but coordinate closely. What all of these clinics have in common is a core group of physicians with an interest in rheumatic diseases, expertise in the care for these patients and, most important, an enthusiasm for collaborating with other specialists.

In our opinion, when set up and operated correctly, multidisciplinary clinics are extraordinarily beneficial for patients, exciting and intellectually gratifying experiences for clinicians and should be the standard of care in academic rheumatology departments.

Rheumatology & Dermatology

The Center for Excellence in Psoriasis & Psoriatic Arthritis & the Rheumatology–Dermatology Clinic

Rheumatology and dermatology are natural areas for collaboration, because rheumatic disease patients often have dermatologic manifestations and vice versa. The Center for Excellence in Psoriasis and Psoriatic Arthritis consists of one rheumatologist and one dermatologist. These providers practice in separate spaces, but closely coordinate their clinical findings and expert opinions.

The Rheumatology–Dermatology Clinic, on the other hand, operates in a shared clinic space and time, one half-day each week. This clinic consists of two dermatologists with expertise in systemic inflammatory disorders and two rheumatologists with respective expertise in lupus, scleroderma and vasculitis, as well as learners at all levels.

Patients who need to see both dermatologists and rheumatologists—for example, a patient with active cutaneous and systemic lupus—will be scheduled for two appointments. For the most part, however, the four providers in this clinic see separate patients and consult with each other when necessary in a shared workroom. Common examples include a rheumatology patient with palpable purpura who needs a biopsy, or a dermatology patient who has cutaneous lupus and needs to be evaluated for systemic involvement.