He continues, “It is a little bit different than when you have primary responsibility for a patient, but everyone takes responsibility. You take responsibility for assuring that your recommendations are reasonable in the context of the patient’s problem.”
From Dr. Coblyn’s perspective, patients with acute problems benefit from the fact that now an attending is always available: In the rheumatic unit model, the attending rheumatologist would often be away seeing clinic patients during the day. In terms of patients’ perspectives, he notes, “I think it’s a little harder for them, because there are so many more people now involved in their care. They get mixed messages from attendings, from residents—there are just so many more people involved.”
Some dedicated rheumatic disease units still operate internationally, with patients hospitalized for rehabilitation over longer periods of time. Yet Dr. Matteson notes that Western Europe is transitioning more toward hospitalization for acute care only.
Dr. Matteson describes another model: “In Berlin, they have something called ‘Daycare hospital.’ You come in for a full day to the hospital and do rehab. You might go home and come back the next day and do that for a week or two. But you’re not really staying in a hospital bed then. You are coming to an intensive rehabilitation program. That’s another variant of the modern rheumatology hospital service.”
He also notes he has colleagues in China who still work on dedicated wards for rheumatology patients, similar to the model that used to be so common. But in the U.S., such units are a thing of the past, an organizational structure from a bygone medical era.
Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.
References
- Ogryzlo MA, Gordon A, Smythe HA. The rheumatic disease unit (R.D.U.) concept. Arthritis & Rheumatism. 1967;10(5):479–485.
- Liang MH. History of the Robert Breck Brigham Hospital for Incurables. Boston,:2013;Brigham and Women’s Hospital Inc.
- Clarke AE, Esdaile JM, Hawkins D. Inpatient rheumatic disease units: Are they worth it? Arthritis & Rheumatism. 1993;36(10):1337–1340.
- Upchurch KS, Kay J. Evolution of treatment for rheumatoid arthritis. Rheumatology (Oxford). 2012;51(Suppl 6):vi28-36.
- Rheumatic diseases in America: The problem, the impact, and the answers. American College of Rheumatology. (n.d.);1–17.
