Rheumatologist Recalls Personal Experience with RA

I have a better understanding of patients’ lack of precision in answer to my questions. For example, a common question for a patient with rheumatoid arthritis is the duration of morning stiffness. I have found that it’s difficult to answer succinctly when one morning the stiffness lasts three hours, and the next day it lasts 20 minutes, and the next day it never quite goes away, but I was in the car for four hours. This topic was explored in a recent paper.²

Dr. Piecyk has been able to resume hiking, an activity she loves.

I have a new understanding of the risks and benefits of medication. I have experienced weight gain and insomnia while taking prednisone, hair loss and elevated liver enzymes due to methotrexate, and injection-site reactions with TNF inhibitors.

My experience with rheumatoid arthritis has also made some aspects of being a rheumatologist more difficult. The more similarities between a patient and myself, the more difficult it can be to remain objective. For example, I don’t want my own experience to influence my choice of medication for patients. If a medication did not work for me, it might still be helpful for someone else. I have also felt that I am sometimes a less effective physician to those patients with minor symptoms. This was apparent especially when I first developed symptoms and during flares. I found my patience decreased as I sat there with hand, hip, ankle and foot pain, while the patient in front of me went on and on about an intermittent thumb pain. If I was struggling to make it through the day, having compassion for a patient with a minor musculoskeletal symptom was honestly difficult. I am no longer just the doctor, but a doctor influenced by her own experience as a patient.

Another issue as a physician-patient is whether I should share my own experience with my patients. I have disclosed if I think it will somehow improve the patient’s care. (Editor’s note: Also see “Tips for Physicians on Handling Personal Problems at Work.”) Although this knowledge can create a strong bond in the doctor–patient relationship and help the patient feel less alone, I don’t want the patient to feel responsible for me or to feel guilty if they are doing better than me. It makes me more vulnerable, and perhaps more human, in the patient’s eyes, but seeking understanding from a patient is also a selfish act. The focus of the visit should be on the patient and not on me.