The search for knowledge has shaped Western culture and is based on Greek philosophy, especially Aristotelian metaphysics. During the Middle Ages, this knowledge was matured by dialectical scholasticism, culminating, in its later stages, in the amalgam between Islamic science and the neo-Aristotelianism of St. Thomas Aquinas.1 In this way, the foundations of the future scientific…
Our hospitals have had their finest hour in the care of acutely ill inpatients during the COVID-19 pandemic, including dealing with allocation decisions fairly and transparently, maximizing good outcomes and remaining cognizant of the enduring ethics of healthcare. The honorable traditions of self-effacing conduct and acceptance of some level of personal risk by healthcare professionals…
In a December 2019 editorial in the Journal of the American Medical Association, the implications of diagnostic error were explored through the story of two parents, both medical professionals, who sought a diagnosis for their sick child.1 Their son saw specialist after specialist and underwent repeated procedures, but for years was left without an explanation…
The ACR position statement on access to care proposes the goal that “… all patients have timely access to expert rheumatology care … .”1 The reality is that new and established rheumatology patient wait times are often prolonged, causing delays in necessary diagnosis and treatment. The 2005 and 2015 ACR Workforce studies document intractable and…
No event in recent history has caused such far-reaching changes within the medical industry as the ongoing COVID-19 pandemic. Similar to its ability to spread indiscriminately—infecting people regardless of age, race or socioeconomic background—the virus is inducing immediate and, likely, permanent changes across the entire spectrum of healthcare. Comfortable routines of healthcare delivery have been…
As a veteran rheumatologist, I remember the clinical trials of etanercept’s (Enbrel’s) efficacy. And when the drug was first approved in 1998, I participated in those clinical trials and realized the effectiveness was astonishing. It was easy to tell which patients were treated with etanercept vs. those who received placebo, even though both groups were…
The College’s principal journals have been telling the tale of workforce woe, exploring the reasons for our predicament and potential solutions for the long and short term.1,2 Among the medium-term remedies is increased use of advanced practice clinicians (APCs), as we collectively refer to nurse practitioners and physician assistants in rheumatology practices. Solutions Estimates of…
As we turn the corner on the second decade of biologic use for rheumatic disorders, a reappraisal of approach in our communication with patients is due. In practice, the impact these agents have on patients’ lives justifies the friction rheumatologists face when connecting patients to them. You can understand why older rheumatologists who apprenticed on…
I attended medical school in the 1960s, when Dr. Lawrence Weed reinvented the medical record to organize and leverage the physician’s patient evaluation for clarity and quality of care—what he dubbed “the problem-oriented medical record.”1,2 My internal medicine house officer training at Massachusetts General placed a high value on efficient, effective medical records and communication…
In late March 2012, I awoke with pain in my left hand. I had difficulty moving my metacarpophalangeal (MCP) joints. They did not move smoothly, but clunked. As I repeatedly attempted to open and close my hand, I realized that I had morning stiffness. As the pain and stiffness gradually improved over the next hour,…