The virtue of appreciating the common extends beyond diagnosis. Common conditions can often be just as disabling as rare ones, if not more so, due to their prevalence and chronicity. Patients with osteoarthritis, for example, may suffer daily pain and significant functional limitations, yet the gravity of their condition is often overlooked in medical settings. Our billing and coding system makes things even worse because medical decision making, the biggest criterion for billing and reimbursement, is driven largely by complexity.
6) Thoughtfulness Over Common Stupidity
Dr. Asher’s “common stupidity” referred to the rote following of protocols without thought or reflection. In rheumatology, our healthcare systems have forced us into fail-first, step therapy, placing costs for insurance companies ahead of therapeutic rationale. Layers of administration and bureaucracy, through tools like prior authorization and peer-to-peer phone calls, have eaten away at our agency to be thoughtful. Despite these developments, thoughtfulness remains the key to providing personalized care, especially in rheumatology, where no two patients present exactly the same way.
Thoughtfulness also means taking the time to consider and acknowledge each patient’s unique circumstances—their history, their lifestyle, their preferences—before making clinical decisions.
It means questioning whether an additional test is truly necessary, or if the information we already have is sufficient to guide treatment. Will that ESR really change our decision making? Do those ACE levels in sarcoidosis even make sense? Will a complete blood count (CBC) with differential provide any more information than a regular CBC? These mundane questions are profound if we embrace thoughtfulness over automatisms.
In many ways, thoughtfulness is about humility. It requires us to recall that medicine is not an exact science. We must remain flexible and open-minded in our approaches because the only certainty that we have is that the patient is sitting in front of us.
By practicing thoughtfulness, we ensure our care is responsive, adaptive and, most importantly, centered on the patient.
7) Diligence Over Sloth
Lastly, modern rheumatology demands unwavering diligence. With diseases whose activity levels relapse and remit sometimes unpredictably, diligent follow-up and meticulous attention to detail are what keep our patients even somewhat stable. Sloth, as Dr. Asher defined it, isn’t just laziness; it’s the failure to engage deeply with the nuances of care—relying on excessive tests instead of engaging in observation thorough careful history taking and physical examination.
Diligence also means keeping up with advancements in our field. The treatments available today, even compared with those from 10 years ago, have transformed rheumatology practice. To offer the best care, we must stay informed, continually learning and refining our approach. But, obviously, I don’t need to remind you of that, regular reader of The Rheumatologist.
