When Rheumatologists Are a Patient’s Second or Third Choice for Medical Opinion

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Outside Exam Room No. 5, the chart rack was empty, so I assumed my new consult was late. Just in case, I looked back over my shoulder as I passed by the partially open door and glimpsed the lower half of a woman holding a three-ringed binder on her lap. I squinted and took a step closer. The left knee looked swollen.

Hmm … I ambled over to the nursing station, where Joanne was on the phone with a local pharmacy. The inability to review the records before seeing the patient had taken me out of my normal routine. “Room 5?” I asked, as Joanne hung up. “Is she my next consult?”

Joanne ran her finger down the patient printout. “Right. Emily Corinth. She said she wanted to hold onto the records. I told her you usually like to review the records before the visit, but she said she’d prefer to tell you the story from the beginning. Fresh.”

“Okay,” I said, the inflection in my voice indicating otherwise. “That’s fine. Nothing else for me to review ahead of time? Did she fill out the office questionnaire?”

“No.” Joanne smiled. “Good luck.”

“Thanks.”

I lingered outside the exam room. A binder usually means that multiple consultants have seen the patient. Having it fed to me selectively, page by page, makes it clear that the patient disagrees with some or all of the previous opinions. Lab or radiographic studies may be conflicting. Medications have been prescribed, and they’ve been either ineffective or poorly tolerated. I am about to hear a medical journey from a particular viewpoint. Hold it. Take a deep breath. She’s a patient with a problem. Focus.

I turned back toward Joanne and whispered, “What did she look like when you roomed her?”

“She was limping,” Joanne answered.

“Okay. It’s her knee. That’s helpful.”

I stepped back toward the door. It’s not a good sign when I have to consciously clear my preconceptions before a consultation. I felt at a distinct disadvantage not knowing anything about Ms. Corinth’s case and—I’m willing to admit—mildly irritated. Based on my previous experiences, this next hour will not go well for either of us. On the other hand, I reminded myself, hearing the story from the beginning may provide clarity rather than grayness. Don’t prejudge. Clear your mind; she has a swollen knee. Let’s see if you can help.

The Journey Begins

“Ms. Corinth,” I extended my hand. “Good morning. What can I do for you today?”