The Secret Lives of the Rheumatologist

Clark Kent, Hannah Montana, Dexter Morgan, David Bowie and your friendly neighborhood rheumatologist: What do all of these people have in common? Chances are, they live secret lives we rarely get to peer into. Unlike Superman, Miley Stewart, Dexter Morgan and Ziggy Stardust, rheumatologists are very much real, flesh-and-blood characters. Rheumatologists also have secret lives that are much more fascinating and intriguing than those of these rock stars, superheroes and sociopathic detectives. What do I mean? Let’s rheuminate!

1. The Adventures of the Practicing Rheumatologist

To be fair, there is no prototypical rheumatologist. Our job descriptions are wide-spanning, with many of us leading in communities through private practice, some devoting our careers to research and education in the academic sphere, and others still in industry, public service and beyond. Despite this heterogeneity, I would contend that most rheumatologists are still living more than one life. In fact, the job description demands it.

For example, the everyday work of the rheumatologist requires more than 24 hours to complete. We have extended ourselves from being doctors for musculoskeletal conditions, from which the original rheum prefix in rheumatologist derives, to becoming immunologists in our own right. Therefore, for every patient we see in clinic, there are two clinician minds stuffed in one body.

Add to that the critical roles that we play as preventive health specialists. Our patients, living with chronic immunologic conditions, often require detailed, holistic guidance that goes well beyond inflammation. From ensuring timely vaccinations to offering lifestyle modifications for preserving cardiovascular and bone health, our conversations frequently mirror those of primary care providers. In many ways, we serve as the integrators of long-term health. So add another secret clinician to the mix.

Further, we are inherently (and secretly) advocates. Whether it’s battling for prior authorizations, writing peer-to-peer appeals or helping patients navigate disability services, rheumatologists spend considerable parts of our day fighting large systems that have not been built to accommodate patients with chronic autoimmune disease. Sometimes, this advocacy role can occupy more of our time than diagnosis or management.

Finally and perhaps most secretly, we are writers. With each note, we attempt to document the complexity of our patients’ journeys in ways that are meaningful to ourselves, our colleagues, our patients and future historians of care. We have to do this as rheumatologists because our patients are that complicated. And yet this unique style of writing and documenting is rarely, if ever, discussed. It is as if it is another secret identity.