At the Johns Hopkins School of Medicine Division of Rheumatology, Baltimore, registered nurses (RNs) are an integral aspect of the rheumatology fellowship program. This gives the fellows information and insight into areas of practice they might not otherwise receive. “This [practice] is a result of our very strong belief that an integrated and interdisciplinary approach,…
Like the medical profession itself, the education of doctors serving in rheumatology fellowships across the nation marches on despite the unexpected hurdles posed by the COVID-19 pandemic. Practice Changes “The pandemic has changed the way our fellows see patients; we are now seeing almost all patients using telemedicine,” says Bonita Libman, MD, FACR, FACP, fellowship…
As rheumatologists, we relish the thrill of diagnostic conundrums that accompany our immune-mediated multi-system and often undifferentiated disease processes. Many rheumatologic diagnoses are essentially diagnoses of exclusion. We’re accustomed to diagnosing iatrogenesis, infection and malignancy as often as we diagnose rheumatic disease. Complex clinical problem solving and critical reasoning are our forte, and to do…
For most rheumatologists, the key elements of the physical exam—inspection, palpation, percussion and auscultation—have long been second nature, but a fifth modality has grown in importance with respect to making the correct diagnosis: ultrasound. From evaluating for Doppler signal and additional findings indicative of synovitis to identifying bony erosions, chondrocalcinosis, tophi and other articular and…
If you’re a rheumatologist, you likely remember the moment of truth on your match day—the day of revelation, when the complex computer algorithm set up by the National Resident Matching Program (NRMP) accommodates the wishes of programs and applicants and then discloses into which program an applicant has been placed. Although it has always been…
My fellow was laughing at me. By itself, I don’t think this was an unusual occurrence. I am quite certain that my fellows laugh at me all the time. That said, when such laughter is called for, I am accustomed to a certain protocol being observed. In general, I expect the laughter to be contained,…
It has been about 20 years since the Institute of Medicine (now the National Academy of Medicine) published the report To Err Is Human: Building a Safer Health System, shining light on the impact of medical errors in healthcare.1 In response to that publication, the focus on quality improvement (QI) started in the inpatient setting,…
The COVID-19 pandemic is reshaping clinical rheumatology and the fellowship experience. Rheumatology education should include how to triage patients for remote visits, says second-year fellow Kanika Monga, MD…
COVID-19 has generated an outpouring of fast-paced, late-breaking new developments. The majority of countries (188) around the world have reported cases of COVID-19.1 As of April 1, 2020, the Centers for Disease Control and Prevention had reported cases in every U.S. jurisdiction (50 states, District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands and…
My first-ever medical mission trip, after 37 years of medical practice, was to Teleman, Alta Verapaz, Guatemala. Prior to the trip, my excitement as an adult-trained rheumatologist was balanced against my apprehension about witnessing new diseases, caring for children and practicing in an austere environment with limited medical resources. As directed by the travel clinic,…