I don’t need to tell you that rheumatology is a field in which many of our patients often feel like their lives are spinning out of control. Good manners can help empower patients in their quest to restore a sense of dignity and respect. It’s worth noting that politeness is more than just etiquette; it’s an acknowledgment of the patient’s humanity in corporatized healthcare systems that can often feel depersonalized. It is a reminder of a critical asymmetry: We may see dozens of patients each week, but for patients, their appointment is a significant, and often stressful, event.
One way in which Dr. Asher’s paper has not kept up with the times is the increasingly multidisciplinary and interprofessional nature of medicine. Rheumatologists work closely with a range of other clinicians and professionals—from nurses and physical therapists to radiologists and pharmacists. Polite, respectful, inclusive and equitable communication within these teams not only fosters a better working environment, but ensures that patient care remains cohesive and seamless.
4) Holistic Perspective Over Overspecialization
Dr. Asher warned against the dangers of overspecialization—a trend that has only grown more pronounced with the increasing complexity of modern medicine.5 While specialization is crucial for deep expertise, we must also remember the broader context of our patients’ health. Rheumatologists, in particular, need to adopt a holistic perspective because autoimmune diseases often have wide-ranging effects on the body and mind.
Our patients are not just their joints or their inflammatory markers. They are whole people, often dealing with comorbidities, such as cardiovascular disease, diabetes or depression. Taking a holistic approach means paying attention to how their rheumatic condition interacts with these other health issues. It means considering how social determinants of health, such as access to care or socioeconomic status, inevitably influence their disease and its management.
Overspecialization is also a sinful development within the sphere of research. With funding drying up in recent decades, researchers are now concentrated within silos focusing on very specific projects. The overarching scientist who synthesized knowledge by dabbling in this and that is a thing wholly of the past. It’s understandable why that has occurred, but it’s nevertheless lamentable that we don’t have the same broadness of scientific inquiry.
5) Appreciation of the Common Over Love of the Rare
It is beyond a cliché now that physicians are on the hunt for zebras—rare and exotic diseases—when they should be paying attention to the horses in front of them. Dr. Asher criticized this love of the rare, which he termed spanophilia, for diverting attention away from more common, but equally important, conditions. In rheumatology, where we frequently encounter rare diseases, this temptation is even greater. However, we must always remember that rare manifestations of common conditions like osteoarthritis, gout, or rheumatoid arthritis are more likely than common manifestations of rare diseases.
