Although when I was a medical student, rheumatology was always associated with an air of mystery and complexity to me—factors that might have aroused a younger me had they been associated with a member of the opposite sex—the specialty didn’t catch my eye at all as an undergraduate. To a medical student cruising for medical action in the 1980s, rheumatology wouldn’t have gotten as far as a first date.
Some medical specialties are cooler and sexier than others. Rheumatology could never really compete with the macho surgical cool of heading down to theater to sew a hand back on, performing open heart surgery, or with the laid-back anesthetic cool of medically paralyzing someone, stopping their heart and lungs, and then starting them up all over again (while reading the paper). Rheumatologists just didn’t wear leather jackets.
If I’m honest, the first thing I liked about it was that it seemed like a bit of a doss. In my first few weeks that summer, I found myself regularly clipping my on-call beeper to the net of the hospital tennis courts to hit a few balls with another member of the team, waiting for “something to happen.” Although it was a false dawn (the job became much busier in the following weeks), I allowed myself to imagine a job that allowed a life outside medicine.
I resigned myself to the certainty that if I were to become a rheumatologist, I’d never own a Porsche. But then neither would I have to drive it to the emergency room in the middle of the night to unblock someone’s coronary arteries.
I liked the rheumatologists, too. Most seemed to be very down to earth and have a genuine interest in the lives of the people they cared for. It seemed to be a specialty where at least some stuff could wait until the morning. This allowed those I worked with to have a measured commitment to the workplace that seemed to leave room for time with family and friends and for nonmedical interests. Because rheumatology is not as well paid as some other specialties, I resigned myself to the certainty that if I were to become a rheumatologist, I’d never own a Porsche. But then neither would I have to drive it to the emergency room in the middle of the night to unblock someone’s coronary arteries.
The Magic Is the Patients
Rheumatologists also seemed to have a level of familiarity with their patients that I imagined an older rural family doctor might have, effortlessly blending the catch-up familiarity of a chat between old friends with the medical business of dose adjustments, joint injections, and referrals to orthopedics. Whereas I now know that this approach and those relationships can take many years to develop, I liked its feel.
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.
