A senior rheumatologist with extensive experience in the management of systemic lupus erythematosus is asked to help draft clinical guidelines for the treatment of lupus nephritis. Neither she nor her family members receive grant funding nor does she consult with any pharmaceutical or biotechnology companies. She does have strong clinical opinions based on current evidence…
In U.S. medical society boardrooms, far from legislative chambers, social conflict is forcing board members to deal with laws that raise issues of medical ethics. Take the Association of University Radiologists (AUR), a group of more than a thousand medical school radiology faculty whose stated mission is to “inspire and educate the academic radiology community.”…
A 60-year-old woman with a six-month history of retroperitoneal fibrosis transfers her care to you. She initially presented with severe bilateral flank pain radiating to the abdomen and chest. A computerized tomography (CT) angiogram of the abdomen demonstrated an infrarenal abdominal aortic aneurysm surrounded by a thick inflammatory rind entangling the left renal vein and…
On Feb. 9, 2019, protesters gathered at the Guggenheim Museum in New York City to lead a march down Fifth Avenue to the Metropolitan Museum of Art.1 As a general rule, news from the world of art is not a topic discussed in these pages, but if you indulge me for just a little bit…
NEW YORK (Reuters Health)—The 2019 edition of the American College of Physicians (ACP) ethics manual provides a six-step approach to resolving ethical dilemmas and adds or expands sections that address emerging issues in 21st century medicine.1 “The Manual provides succinct guidance on issues that affect the patient-physician relationship, and also issues that have to do…
We have all been to numerous lectures, grand rounds and other continuing medical education activities where the speaker, prepared and poised at the podium, begins his lecture with a title slide. Soon after, we see the ubiquitous conflicts of interest slide, which lists the invited speaker’s research funding, his consulting activities and his board memberships—all…
You are seeing a hospital consult late in the afternoon on a Saturday. The patient has suspected, new-onset lupus with inflammatory arthritis, renal failure with nephrotic range proteinuria and a malar rash. You plan to start the patient on high-dose IV steroids, and you decide to speak to the nephrologist on call first. When he…
Effective management of healthcare compliance requires an office compliance plan that stays current with changing government regulations, payer requirements, office operations and technology. Many still wonder, why is a compliance program needed—if something isn’t broken, don’t fix it, right? This is not always the case; compliance is an essential part of practice operations, but providing…
A 67-year-old man with a recent onset of diffuse muscular pain and stiffness and an erythrocyte sedimentation rate of 55 is referred to you by his family practitioner. He has a history of non-insulin-dependent diabetes mellitus, but no history of headaches or swollen joints. He has chronic back pain, has had two surgeries and was…
A 54-year-old woman is establishing care in your clinic after retirement of her previous rheumatologist. Your review of her records suggests that she was diagnosed with systemic lupus erythematosus seven years ago on the basis of symptoms of body pain and fatigue, and serologic evidence of positive ANA 1:40 (speckled) and borderline anti-SSB antibody. She…