A common case scenario in our practice in North Dakota is a woman with rheumatoid arthritis on methotrexate monotherapy. She is a member of the Sisseton Wahpeton Oyate people and lives 90 miles from our rheumatology clinic. She currently has moderate disease activity, indicating the need for additional treatment. She does not have her own…
Ethics Forum: Thoughts on Managing Electronic Communication with Patients
Recent proposals in the U.S. to bill for electronic communication with our patients could be seen as a refreshing but contested attempt to battle burnout rates in the present era. A fee for electronic communications between patients and clinicians also acknowledges the value of the clinician’s time and expertise. But is this ethical? Discussion Burnout…
Ethics Forum: Has the Patient Asked for More Than Can Be Ethically Allowed?
The patient, a 76-year-old woman, had very active polyarticular rheumatoid arthritis (RA), despite triple therapy with conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs), low-dose corticosteroids and occasional intra-articular injections—the latter providing only transient symptomatic relief. She had elevated inflammatory markers and a 28-joint Disease Activity Score (DAS-28) score of 7.4. Because of the severity of her…
Ethics Forum: Billing, Burnout and Protected Non-Clinical Time
It’s 11 a.m. on a Wednesday. You see a new patient in your fellow’s clinic with impressive physical findings, including a prominent skin rash and deforming arthritis. The patient has been to many doctors and is frustrated that her condition remains undiagnosed and untreated. You thoroughly examine the patient, present her case to your attending…
Ethics Forum: Balancing Competing Interests to Meet Patients’ Needs
Scenario: A patient with rheumatoid arthritis (RA) presents for a follow-up visit. After addressing her inflammatory arthritis symptoms, medications and laboratory results, she is asked if she has any other questions, and she begins describing her chronic low back pain, which has become worse despite physical therapy (PT). She requests stronger medications because her RA…
Ethics Forum: Vaccine Mandates
With the ongoing COVID‑19 pandemic, several tools and strategies have been developed and implemented to reduce the spread of disease. These include social distancing, adequate ventilation, masks, monoclonal antibody treatment and vaccination.1 As of December 2021, 60% of all Americans have been fully vaccinated, and 8 in 10 adults in the U.S. have received at…
Ethics Forum: To Test or Not to Test?
“Maria” is a 54-year-old woman with seropositive rheumatoid arthritis, as well as hypertension and hyperlipidemia. She is a new patient in your clinic following a move across the country to live with her children on a farm in a rural area of the Midwest. At her first visit, three months ago, you and Maria agreed—through…
Considerations for Rheumatologists on Twitter: Ethics Forum
Scrolling through your Twitter feed, a tweet catches your eye: “Great day. Helped anxious patient with poor health literacy understand and come to terms with #SLE diagnosis and agree to start treatment. #RheumTwitter” The tweet, by a well-intentioned physician who cared deeply for her patient, resonated with many others and has been retweeted more than…
Ethics Forum: Who Did You Vote For? Is a Discussion of Politics in the Medical Office the Taboo It Once Was?
Is it taboo to talk about politics during the office visit? My morning routine may sound familiar to many of you: I wake up and get ready for work. Before I step out of my car, I put on my mask. I go inside the office to greet the staff and to get my temperature…
Ethics Forum: The Ethical Considerations of Prior Authorization
The mother of a 15-year-old patient with juvenile idiopathic arthritis/enthesitis-related arthritis (JIA/ERA) called the office in tears. She said she was having an insurance problem. Her son had been a star track athlete when he developed severe back pain. Magnetic resonance imaging showed evidence of severe sacroiliitis. He was started on a tumor necrosis factor…