Admittedly, this is easier said than done. With an increasing array of tongue-twisting generic medication names, an alphabet soup of cytokines that are targets for immunomodulation and advances in basic immunology knowledge that confound more than elucidate, you can understand why there’s a tendency for obscurity. Worse yet, we know that poor health literacy compounds rheumatologic disease and leads to worse outcomes. Therefore, we owe it to our patients to simplify our language as much as possible without diluting our message. Personally, in my clinic, I use the three-syllable rule (adapted from mentors in Kentucky where I completed my residency): All words at the bedside should consist of three syllables or fewer, and when that’s unavoidable, a full explanation is mandatory (e.g., immunomodulator, autoimmune).
2) Compassion Over Cruelty
Dr. Asher’s second sin, cruelty, may sound extreme to our modern sensibilities, but the casual thoughtlessness he described remains all too familiar in today’s clinical environments. Whether it’s the insensitivity of a hurried appointment or the lack of awareness of how deeply a patient’s disease impacts their life, cruelty can manifest subtly, even unintentionally. Rheumatology, perhaps more than many other fields, requires a heightened level of sensitivity and compassion because we often treat patients whose pain and disability are invisible to the outside world, but very real to them.
Compassion in rheumatology doesn’t mean passively offering a sympathetic ear. It means truly seeing the patient in front of you—their fears, frustrations and hopes—and recognizing the emotional weight that comes with chronic illness. Our patients are not experiencing physical symptoms alone; they are navigating a complex emotional landscape, filled with incredible uncertainty. Compassion means staying present with them through their struggles, validating their feelings and offering support that extends beyond the clinical encounter.
Moreover, compassion isn’t just for our patients—it’s for ourselves and our colleagues as well. The burnout epidemic in healthcare has highlighted the importance of self-compassion.4 If we cannot extend grace to ourselves, we risk losing the emotional capacity to care for others. It’s an incredibly sad irony that the cruelty and lack of self-compassion Dr. Asher wrote about eventually consumed his own sense of well-being. Altogether, his words and his life story highlight that compassion—toward our patients and ourselves—transcends being a virtue into a necessity for sustaining long-term, effective practice in rheumatology.
3) Good Manners Over Bad Manners
Good manners may seem a small virtue, yet they are foundational in medicine. Dr. Asher’s critique of bad manners is rooted in the recognition that rudeness, even if minor or unintended, can erode the trust that is so essential in the patient-physician relationship. In rheumatology, where our interactions with patients are often lengthy and frequent, good manners become even more crucial. A simple greeting, a kind word or even just listening without interrupting can make a profound difference in establishing our credibility as clinicians who not only provide care, but actually do care.
