A 17-year-old girl presents to the pediatric rheumatology clinic for follow-up of recently diagnosed systemic lupus erythematosus (SLE) characterized by class IV lupus nephritis, photosensitive rash and antiphospholid antibody positivity. She is currently being treated with prednisone, mycophenolate mofetil, and hydroxychloroquine. She is accompanied by her mother, who has been very involved in the patient’s…
In the middle of a busy clinic I go to see my next patient, a 16-year-old girl with a swollen knee. I had seen her the week before and, after discussing the options regarding treatment of her arthritis, had organized a joint injection for today. As I walk in the door she emphatically informs me,…
Karen Onel, MD, new chair of ACR’s Committee on Ethics & Conflict of Interest, brings a longstanding interest in issues related to ethics and consent.
A 43-year-old woman is establishing care in your new urban clinic after her previous rheumatologist stopped accepting her Medicaid insurance more than a year ago. Since that time, she has been trying to find a new rheumatologist who will accept Medicaid. She lives 90 miles away in a small town without a rheumatologist. Seven years…
Results from an ethics survey presented to attendees at the 2018 ACR/ARHP Annual Meeting highlight the complexities and challenges of assessing potential conflicts of interest.
“And of course, I am not telling you to do it. That would be illegal.” As a general rule, I try not to instruct my patients to break the law. My business model depends on repeat customers, so placing a patient at risk of getting arrested—even if that risk is remote—doesn’t seem like a good…
A senior rheumatologist with extensive experience in the management of systemic lupus erythematosus is asked to help draft clinical guidelines for the treatment of lupus nephritis. Neither she nor her family members receive grant funding nor does she consult with any pharmaceutical or biotechnology companies. She does have strong clinical opinions based on current evidence…
In U.S. medical society boardrooms, far from legislative chambers, social conflict is forcing board members to deal with laws that raise issues of medical ethics. Take the Association of University Radiologists (AUR), a group of more than a thousand medical school radiology faculty whose stated mission is to “inspire and educate the academic radiology community.”…
A 60-year-old woman with a six-month history of retroperitoneal fibrosis transfers her care to you. She initially presented with severe bilateral flank pain radiating to the abdomen and chest. A computerized tomography (CT) angiogram of the abdomen demonstrated an infrarenal abdominal aortic aneurysm surrounded by a thick inflammatory rind entangling the left renal vein and…
On Feb. 9, 2019, protesters gathered at the Guggenheim Museum in New York City to lead a march down Fifth Avenue to the Metropolitan Museum of Art.1 As a general rule, news from the world of art is not a topic discussed in these pages, but if you indulge me for just a little bit…