I liked the mix of clinical problems coming along to the office—in a single morning you could see patients with tennis elbow, rheumatoid arthritis, gout, osteoporosis, osteoarthritis, vasculitis, lupus, and even a few of the worried well. There was a nice mix of clinical medicine (where most of the clues are there from listening and examining), a bit of hi-tech imaging (with magnetic resonance imaging and nuclear medicine), and a bit of nerdy hardcore science and immunology thrown in. Most of all, though, I liked the patients.
Rheumatology patients are an amazingly strong, patient, and forgiving group of people. They are often cheerfully resilient while coping with the ravages and disappointments of living with a chronic disease, and patient in their wait for slow-acting treatments to work (and when our clinics run behind!). They forgive rheumatologists when initial attempts to treat their disease fail (we’ve sometimes got to chop and change until we get the right cocktail for every patient), but always express gratitude when things go well.
Thankfully, rheumatology is entering a new era. The vast majority of patients with rheumatoid arthritis will do very well on treatment. The impact that modern treatments have had on joint damage means that, for most patients, joint deformities are rare; as a result, referrals to orthopedics and plastic surgery have dropped.
Outcomes from sometimes fatal connective tissue disease like vasculitis and lupus have improved dramatically and we are now very good at treating gout and osteoporosis and getting better with chronic pain management.
Although I always thought that rheumatologists had reason to feel good about their role in the lives of their patients and their place in medicine, I think it is about time we added a little swagger to our ward rounds. I think I might just pop out and buy myself a leather jacket.
Dr. Kavanagh is a rheumatologist in private practice at Western Rheumatology in Galway, Ireland. He also runs The Musicians’ Clinic in Galway. This article was originally published on his blog, www.ronankavanagh.wordpress.com, and you can follow him on Twitter @ronantkavanagh.
