Although when I was a medical student, rheumatology was always associated with an air of mystery and complexity to me—factors that might have aroused a younger me had they been associated with a member of the opposite sex—the specialty didn’t catch my eye at all as an undergraduate. To a medical student cruising for medical action in the 1980s, rheumatology wouldn’t have gotten as far as a first date.
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Explore This IssueJanuary 2012
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Some medical specialties are cooler and sexier than others. Rheumatology could never really compete with the macho surgical cool of heading down to theater to sew a hand back on, performing open heart surgery, or with the laid-back anesthetic cool of medically paralyzing someone, stopping their heart and lungs, and then starting them up all over again (while reading the paper). Rheumatologists just didn’t wear leather jackets.
At that time, and despite its best efforts, my chosen specialty had an image problem. This wasn’t the fault of the rheumatologists; we just didn’t yet have the effective tools at our disposal to significantly impact many of the diseases we treated. Nonetheless, this affected the attractiveness of our specialty to those choosing a career in hospital medicine and to our colleagues in other specialties. Rheumatologists were seen by their colleagues as specialists who provided a babysitting service, albeit with lots of steroids, to the chronically unwell. Our clinics were full of struggling patients for whom the treatments didn’t work, and there were even special clinics to deal with side effects to the drugs we were prescribing (‘Gold clinics’ were not as glamorous as they sound).
Stumbling into Rheumatology
With my heart set on a career in the rapidly evolving, hi-tech, and terrifically sexy specialty of radiology, I decided to get some general medicine under my belt before going for the interviews. Accidentally stumbling into a few months of rheumatology as part of one of the jobs, I surprised myself by beginning to like the job.
If I’m honest, the first thing I liked about it was that it seemed like a bit of a doss. In my first few weeks that summer, I found myself regularly clipping my on-call beeper to the net of the hospital tennis courts to hit a few balls with another member of the team, waiting for “something to happen.” Although it was a false dawn (the job became much busier in the following weeks), I allowed myself to imagine a job that allowed a life outside medicine.
I resigned myself to the certainty that if I were to become a rheumatologist, I’d never own a Porsche. But then neither would I have to drive it to the emergency room in the middle of the night to unblock someone’s coronary arteries.
I liked the rheumatologists, too. Most seemed to be very down to earth and have a genuine interest in the lives of the people they cared for. It seemed to be a specialty where at least some stuff could wait until the morning. This allowed those I worked with to have a measured commitment to the workplace that seemed to leave room for time with family and friends and for nonmedical interests. Because rheumatology is not as well paid as some other specialties, I resigned myself to the certainty that if I were to become a rheumatologist, I’d never own a Porsche. But then neither would I have to drive it to the emergency room in the middle of the night to unblock someone’s coronary arteries.
The Magic Is the Patients
Rheumatologists also seemed to have a level of familiarity with their patients that I imagined an older rural family doctor might have, effortlessly blending the catch-up familiarity of a chat between old friends with the medical business of dose adjustments, joint injections, and referrals to orthopedics. Whereas I now know that this approach and those relationships can take many years to develop, I liked its feel.