Rheuminations: Imagine a Better World for Clinicians & Our Patients

The world didn’t end on Jan. 1, 2000. The Y2K bug didn’t crash airplanes and liquidate bank assets. We were, overall, hopeful for the future—a new millennium full of futuristic visions of a techno-utopia. Fast forward a quarter of a century and we now live in that technologically advanced age that once seemed so far away. With the advantage of hindsight, things turned out considerably different than we had thought when we entered this century. Yet we carry with us many of the same dreams that come from the 1990s and even earlier.

This year, I hope to honor the importance of that process of dreaming and resolve to dream not just bigger but also better. I’d encourage you to join me in dreaming up a better world for the patients with rheumatologic diseases and the clinicians that serve them. Why and how? Let’s Rheuminate!

The Importance of Dreaming

I have a quote by T. E. Lawrence, also known as Lawrence of Arabia, taped to the side of my desk at work: “All men dream: but not equally. Those who dream by night in the dusty recesses of their minds wake up in the day to find it was vanity, but the dreamers of the day are dangerous men, for they may act their dreams with open eyes, to make it possible.”¹ It’s an ideal that I hold myself to and a reminder that a large part of a rheumatologist’s job is to dream.

As rheumatologists, we live in a world in which progress often feels incremental. New treatments emerge, new mechanisms of disease are unraveled, and yet our patients’ daily realities—pain, disability, uncertainty—can stubbornly persist. In this environment, dreaming becomes an act of defiance. It’s the process of imagining a world that does not yet exist, but certainly could. Dreams give us the courage to question the status quo and the determination to pursue something better for our patients and for ourselves.

In that sense, dreaming is not a frivolous escape from reality; it is a necessary act of envisioning what may be possible. For every transformative innovation in everyday rheumatology, whether it is a new immunomodulator, a reimagined modality of care or an expansion of a clinical practice—there first had to be a dreamer who dared to imagine it. As clinicians, and especially as rheumatologists, we owe it to ourselves and our patients to hold onto our dreams. They are the seeds of change, and without them, progress stalls.

We Can Control Our Dreams

The enduring nature of dreams lies in their mysterious nature. With all our advances in technology, we still don’t understand why people dream and what exactly determines the contents of our dreams. Our forebearers considered dreams to be omens and premonitions of the future, while Sigmund Freud described dreams as windows into our subconscious mind. Today, we hypothesize that dreams are the product of our brains consolidating and processing memories from the day. Anecdotally, this conjecture seems to make sense. I often have dreams that relieve what I did and what I felt during the day, and the most vivid dreams are the ones that elicit the strongest emotions.

What is curious is that while the literal act of dreaming is retrospective and looks toward our past to construct itself, the figurative act is extraordinarily prospective. Dreams are borne out of the reality of today, but are anticipatory of the future.

Our ability to shape these figurative dreams is what makes them so potent. Unlike the uncontrollable narratives of our sleeping mind, our waking dreams—our visions and goals—can be refined, revised and acted upon. By choosing to focus on hopeful possibilities rather than limitations, we afford ourselves agency in shaping the future. Rheumatologists, in particular, must harness this ability, using our unique perspectives to dream up solutions that address the complexities of our patients’ needs.

The Art of Dreaming

Interestingly, not all people dream in the same way. There is an elite group of super-dreamers, of which I am not a member, who engage in lucid dreaming. Lucid dreams are those in which the dreamer becomes aware they are dreaming and uses this awareness to guide the narrative or explore possibilities within the dream. For some, lucid dreaming is a form of practice to simulate reality and confront challenges in a safe, imaginative space.²

What’s fascinating is how lucid dreaming mirrors the deliberate act of creative problem solving in the waking world.³ As rheumatologists, we face the most complex cases in medicine, which demand a curious blend of imagination and precision. Just as a lucid dreamer may experiment within the bounds of their dream, we can experiment within the framework of our knowledge and experience, envisioning new approaches to treatment, patient education or care delivery in the confines of our own clinic spaces.

Dreaming, in this sense, is as much an art as it is a science. It requires both structure and flexibility—a willingness to imagine beyond the obvious while remaining tethered to what is achievable. The most impactful dreams are not those that ignore reality, but those that engage with it creatively, finding new ways to address old problems.

Moreover, dreaming is a nonlinear, iterative process. Rarely do we dream perfectly on the first try. Instead, we revisit our visions, refine our goals and adapt to changing circumstances. This flexibility is key to turning dreams into reality, whether they are dreams of personal growth, professional achievement or systemic change.

Recognizing Dreams

The other fascinating element of dreams is that we tend to forget them easily. No matter how wonderful or vivid they may be, unless they are written down or recorded in some other way, they seem to escape us within a few minutes of awakening. I am often surprised by people who say they never dream. In all likelihood, they do dream but forget those dreams before they can even register them.⁴

A few years ago during the height of the COVID-19 pandemic, I conducted a fascinating month-long experiment and kept a sleep diary next to my bed. Each morning, I jotted down whatever dreams came to mind as soon as I woke up. At the end of the month, I reread my entries. To my surprise, I found that I could recall the dreams as vividly as if they had occurred the night before. This exercise taught me the importance of recognizing and recording dreams—not just the ones that happen in sleep, but the ones that happen in our waking lives as well.

Recognizing dreams requires a degree of intentionality. It means taking the time to reflect on and analyze what we hope for, what inspires us and what we want to achieve. Dreams can’t become the basis of planning until we value them and acknowledge them for what they are: blueprints emerging from our depths our soul to outline a future that we want to inhabit. By documenting our dreams—whether through journaling, conversations or goal setting (often all three)—we bring them out of the realm of the intangible and into the realm of the possible.

Rheum to Dream

So what does a rheumatologist dream about? As a rheumatologist, I have lofty dreams of a world free from the shackles of joint pain. As an immunologist, I envision a world that has fine-tuned the forces of inflammation to only protect the body and the mind. And as a health services researcher, my dream is one in which people from all backgrounds have access to high-quality care that maximizes their quality of life.

While these dreams are inspiring, they are also daunting. To make them feel achievable, I’ve broken them into smaller, more manageable dreams within dreams for 2025. Here they are:

• I dream that I learn at least one profound thing from my patient per encounter. Each patient brings a unique perspective, a lived experience that goes beyond a journal article or textbook chapter. By actively listening and engaging, I hope to not only improve the quality of their care but also deepen my understanding of what it means to live with that rheumatologic disease. This dream reminds me that growth as a clinician comes from humility and curiosity.
• I dream that the rheumatology community remains united in the face of an unprecedented workforce crisis: the growing shortage of rheumatologists is a challenge that threatens patient access and care quality. As a community, we have to remain united and advocate for policies to support our workforce and replenish our ranks. That means that we take our dreams to Washington, D.C., and our state capitals and communicate our dreams clearly with our public servants.
• I dream that our patients have access to high-quality information for self-management and self-care. Empowering patients with knowledge is key to improving outcomes, but high-quality, accessible information in this post-truth era is often hard to find. I dream of a world in which authentic, approachable, and applicable information is available at our patients’ fingertips. It’s only through the realization of that dream that patients can take an active role in managing their health.

Dreams can seem ethereal and fantastical, but they are very much real, and they play important roles dictating the way that we see reality. They are part of mutualistic processes that link our inner mind to the outer world. By learning how to dream more effectively—in both the literal and the figurative senses, we remake ourselves and the world around us on our own terms. Alternatively, if we ignore our natural capacity to dream, we surrender ourselves and our world to the dreams of others, and that is a recipe for a nightmare.

Admittedly, the dream of this rheumatologist, in which joint pain and immune dysfunction are relegated to historic time periods, remains lofty. Yet I’ll hold that dream close to my heart in order to guide my thoughts and actions through this year and this century.

Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS, is the director of the rheumatology fellowship training program at the University of Iowa, Iowa City, and the physician editor of The Rheumatologist. Follow him on X (formerly Twitter) @BharatKumarMD.

References

1. Lawrence TE. Seven Pillars of Wisdom: A Triumph. Garden City, New York: Doubleday.
2. Bonamino C, Watling C, Polman R. Sleep and lucid dreaming in adolescent athletes and non-athletes. J Sports Sci. 2024 Aug;42(16):1566–1578.
3. Lewis PA, Knoblich G, Poe G. How memory replay in sleep boosts creative problem-solving. Trends Cogn Sci. 2018 Jun;22(6):491–503.
4. Dal Sacco D. Dream recall frequency and psychosomatics. Acta Biomed. 2022 May 11;93(2):e2022046.