“Maria” is a 54-year-old woman with seropositive rheumatoid arthritis, as well as hypertension and hyperlipidemia. She is a new patient in your clinic following a move across the country to live with her children on a farm in a rural area of the Midwest. At her first visit, three months ago, you and Maria agreed—through…
Scrolling through your Twitter feed, a tweet catches your eye: “Great day. Helped anxious patient with poor health literacy understand and come to terms with #SLE diagnosis and agree to start treatment. #RheumTwitter” The tweet, by a well-intentioned physician who cared deeply for her patient, resonated with many others and has been retweeted more than…
Is it taboo to talk about politics during the office visit? My morning routine may sound familiar to many of you: I wake up and get ready for work. Before I step out of my car, I put on my mask. I go inside the office to greet the staff and to get my temperature…
The mother of a 15-year-old patient with juvenile idiopathic arthritis/enthesitis-related arthritis (JIA/ERA) called the office in tears. She said she was having an insurance problem. Her son had been a star track athlete when he developed severe back pain. Magnetic resonance imaging showed evidence of severe sacroiliitis. He was started on a tumor necrosis factor…
Prescribing stewardship is just one ethical consideration facing rheumatologists during the COVID-19 pandemic.
A 17-year-old girl presents to the pediatric rheumatology clinic for follow-up of recently diagnosed systemic lupus erythematosus (SLE) characterized by class IV lupus nephritis, photosensitive rash and antiphospholid antibody positivity. She is currently being treated with prednisone, mycophenolate mofetil, and hydroxychloroquine. She is accompanied by her mother, who has been very involved in the patient’s…
In the middle of a busy clinic I go to see my next patient, a 16-year-old girl with a swollen knee. I had seen her the week before and, after discussing the options regarding treatment of her arthritis, had organized a joint injection for today. As I walk in the door she emphatically informs me,…
A 43-year-old woman is establishing care in your new urban clinic after her previous rheumatologist stopped accepting her Medicaid insurance more than a year ago. Since that time, she has been trying to find a new rheumatologist who will accept Medicaid. She lives 90 miles away in a small town without a rheumatologist. Seven years…
Results from an ethics survey presented to attendees at the 2018 ACR/ARHP Annual Meeting highlight the complexities and challenges of assessing potential conflicts of interest.
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…