Second, find a colleague with whom to start an interdisciplinary clinic. Maybe spend a half-day each month in the office of a nephrologist, a dermatologist, a pulmonologist or a neurologist. In our academic division, we established an interdisciplinary clinic with dermatology. Patients benefit from better care, better coordination and assurance their specialists have conferred with one another. Doctors benefit from instant consults and improved teaching and learning. And if your goal is research, you have the perfect population.
I know of an interdisciplinary pediatric rheumatology-ophthalmology clinic in England that’s changed how uveitis associated with juvenile idiopathic arthritis is managed. I know of many successful ophthalmology-rheumatology clinics in Spain. Orthopedists and rheumatologists often practice effectively together in a shared space. Most patients do not object to two bills from an interdisciplinary clinic. If the patient attended two offices, they’d receive two bills anyway, and a great deal of additional time would be spent.
Caution: I’m also aware of attempts at forming an interdisciplinary clinic that have failed. The reasons for failure may be complex, but I suspect one contributor is that both parties ignored advice number one.
Third, encourage your nearest medical school to teach a class, a course or just a grand rounds on communication and collaboration with our professional peers. Several medical schools have started to offer classes on how to communicate with patients; I’m unaware of similar classes about communicating with peers.
We practice shared decision making with our patients, but we often fail to achieve shared decision making with our peers from other specialties.
Final Thoughts
We make compromises for the sake of our families, our careers, our patients and our colleagues. There are professionals who understand and specialize in compromise. Imagine if, for every patient with lupus nephritis, a couple’s therapist could help formulate the therapeutic plan, which often differs between the nephrologist and rheumatologist. We practice shared decision making with our patients, but we often fail to achieve shared decision making with our peers from other specialties.
When couples exchange wedding vows, they frequently assert, “You complete me.” A bride and groom seek to complement each other’s personality and skills. Wouldn’t it be wonderful to fulfill your role as a rheumatologist by hearing from an ophthalmologist, nephrologist or dermatologist, “You complete me?”
On their album, Abbey Road, the Beatles released a song called, “Come Together.” I’ve never understood some of the words (e.g., “ju ju eyeballs”), but the title has stuck with me. As rheumatologists, if we come together with our peers, our patients will benefit, and consequently, we will benefit as well.
