Let me tell you about a recent morning working in my outpatient rheumatology clinic. I’ll tell you less about the medicine, but more about my process of practicing medicine. I hope to shed light on what it’s like to be a physician, behind-the-scenes. As you’ll see, practicing medicine is time-consuming; it takes much more than the time spent with the patient in the clinic or at the bedside. Or at least it does if you really want to take care of your patient. Continue reading This is what it’s like to be a physician
I spent most of my senior year in college in the basement of the science building, in a room the size of a closet, watching (and videotaping) fish having sex. I was studying pipefish, a relative of the seahorse in which the males get pregnant. I was interested in learning how this unusual quirk of evolution affected the sex roles of the fish, asking questions such as: which sex is more promiscuous, bigger, and more aggressive? Evolution was at the heart of my biology major, and its existence was palpable in every biology class I took—from Genetics sophomore year to a senior seminar on Ecology. It was clear during my undergraduate education that “nothing in biology makes sense except in the light of evolution.” Continue reading (R)evolutionary Rheumatology
Every few months I have the pleasure of teaming up with one of my fellows (and often a resident, and sometimes a medical student), to evaluate hospitalized patients with known or suspected rheumatic diseases as part of the inpatient consult service. This is quite a change from my typical day as a rheumatologist, where I see patients in an outpatient clinic.
On occasion, patients with known rheumatic diseases land in the hospital—the patient with lupus and worsening kidney disease, the patient with gout and a severe flare, the patient with vasculitis experiencing a relapse. At the same time, many patients are admitted for workup of unexplained symptoms—joint pain, fevers, rash—or develop these while being treated other conditions. For these patients, we are asked to evaluate for the presence of rheumatic diseases.
Having just finished covering the inpatient rheumatology consult service, I am reflecting on my week and have identified 15 factors that help you achieve a successful week. Continue reading Mastering the Inpatient Consult Service
Autoinflammatory diseases (AIDs) are a rare group of illnesses characterized by unprovoked episodes of fever and systemic inflammation. An understanding of their pathophysiology has led to the development of effective treatment guidelines. Unfortunately, many patients with recurrent fevers have symptoms that do not match any of the known AIDs. There is an unmet need to provide effective treatment to these patients with undefined AIDs (uAIDs). Colchicine, a treatment for patients with familial Mediterranean fever, is sometimes used to treat patients with uAIDs. We examined the efficacy of colchicine in patients with uAIDs and identified clinical factors that predicted a good colchicine response.
Despite the widespread use of temperature measurement in healthcare, our ability to use temperature data to diagnose patients is limited; it remains challenging to distinguish fevers of rheumatic illnesses from those of infectious or malignant conditions. We created Feverprints, a crowdsourcing research app to understand temperature variation between individuals, determine unique fever patterns (“feverprints”) for a variety of illnesses, and examine how antipyretics affect disease course. We report preliminary data from temperatures collected during the first 9 months of the study.