Your Rheumatologist: partnership vs paternalism?

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By Dr Irwin Lim, Rheumatologist

As I read patient comments on social media, I get the sense that many yearn for their rheumatologist to be a partner in navigating their disease and helping them make their treatment decisions.

Rheumatology is difficult. Much of what we treat, and especially with autoimmune arthritis, is chronic, and can have profound effects on patients lives. Treatments can be complicated and scary. We are sometimes guided by scientific evidence, sometimes by experience, and often by our sensitivity, the art of medicine.

There is no doubt that for many of my patients, we work together in coming to decisions.

There are however, equally many patients, that to my mind, do not or cannot take a more active part in their management decisions. Some find it very hard to cope with the diagnosis and rather than go out and garner information, they avoid it.

At our clinic, we have created a lot of resources, both paper-based and web-based, to help education. I haven't formally audited it but I have the sense that it's appreciated by some and probably unused by many.

"Doc, just tell me what to do." "You're the expert."

Often, I need to be directive and the patient needs to be directed.

It might be heresy, in social media circles, to talk about being paternalistic. I don't mean to court complaint.

It's just that different people want and/or need different approaches. Sometimes, doctors get it wrong but most are trying to do the right thing for the people they care for.