OHSU Center for Interstitial Lung Disease
This clinic is a collaboration among three pulmonologists and two rheumatologists in a shared space. The schedules are coordinated so that in one day the patient will have studies done, such as pulmonary function testing, and see each specialty in separate appointments in the same clinic space. Rheumatologists and pulmonologists share the same workroom for discussing patient care decisions and easier coordination.
OHSU Vasculitis Center
The OHSU Vasculitis Center includes specialists from rheumatology, dermatology, nephrology, pulmonology, ophthalmology and otolaryngology. With the exception of dermatology, these providers do not share clinic space or time. Each member has experience, interest and expertise in treating patients with vasculitis. In fact, many of these patients are first recognized as having vasculitis in clinics outside rheumatology.
Here, the rheumatologist is usually at the center of patient care and coordinates with all other specialists, although in some cases the primary disease manifestation is localized to one organ system, and in such cases that provider leads in management.
The rheumatologist coordinating a patient’s care relies on the assessments and findings of other specialists. For example, patients with granulomatosis with polyangiitis and subglottic stenosis see an otolaryngologist early in the morning when they undergo laryngoscopy, and then come to the rheumatology clinic where the results of the laryngoscopy guide care decisions.
OHSU Myositis Clinic
This clinic consists of one rheumatologist and one neurologist, and takes place in a shared space once monthly. Each patient has one appointment in which a rheumatologist and a neurologist see the patient together in the same clinic room. The neurologist performs a detailed neurologic exam, and the rheumatologist evaluates for extramuscular disease. Having the perspective of both fields allows these providers to formulate a comprehensive treatment plan.
Rheumatology–Ophthalmology Clinic
The inflammatory eye disease clinic specializes in uveitis, scleritis, dry eyes, orbitopathies and other inflammatory eye diseases. This clinic takes place in a shared place and time, and consists of one rheumatologist with unique expertise in inflammatory eye disease, ophthalmologists, a uveitis fellow and other trainees.
Advantages of a Multidisciplinary Clinic
Convenience for patients traveling from a long distance: OHSU is located in a major metropolitan area, but much of the surrounding region has limited or no access to specialty care. Patients from Oregon, Idaho, southern Washington and even Alaska travel to the university for their specialty care. For such patients, it is a tremendous advantage to see numerous specialists during the same visit and be able to leave with a comprehensive plan of care. Many rural areas lack access to a rheumatologist or pulmonologist;
however, at our Center for Interstitial Lung Disease, a patient with rheumatic disease-
associated interstitial lung disease, for example, can make one trip, be seen by both specialists, undergo a full workup and leave with a coordinated care plan.
Provision of urgent/emergent care: Rheumatic emergencies can be difficult to diagnose and understand for the untrained eye. In one of the cases presented above, we mentioned a patient with a history of neuro-
Behçet’s disease who presented for a routine Friday afternoon clinic visit reporting newly reduced vision in one eye. The rapid availability and coordination with ophthalmologists who have expertise in inflammatory eye disease resulted in a same-day appointment, a diagnosis of optic neuritis and rapid vision-saving treatment. Without access to this type of coordinated care, this complaint would have required an emergency department visit.
Similarly, when one of our other specialist partners calls with a high index of suspicion for a new rheumatic diagnosis, an appointment can be expedited. A major advantage of a multidisciplinary clinic is access to other specialists who understand rheumatic disease, trust each other’s assessments and can directly coordinate urgent care without the need for cumbersome referral processes.
Communication ease: Communication with providers outside one’s institution (and often even within the same institution) can be difficult and inefficient. Most rheumatologists can likely think of at least a few recent examples in which patient care was delayed or suboptimal because of difficulty getting in touch with another provider. The personal relationships and collegiality created by working together in a multidisciplinary clinic are key to establishing open lines of communication. In some cases that communication happens face to face—“The patient has lupus rash and signs of systemic lupus,” or “We can schedule a bronchoscopy to evaluate for infection this week.” In other cases, this communication happens over the phone, by email or through the medical record, but typically communication is rapid and efficient.
