By Dr Irwin Lim, Rheumatologist
This year has flown by, frighteningly quickly. I think that implies that it was busy and overall enjoyable.
Writing this blog has been an important part of my year and I’d like to thank you all for your support. It definitely keeps me going.
I’ll admit that the enthusiasm has waned in recent weeks. I’ve been feeling lazy and less motivated, the blogging has seemed hard work. The end of year holidays are needed.
I sat down yesterday to review what I’d written for the year. Here’s a selection of the posts I thought most useful or enjoyable.
Listening to Professor Ted Pincus led to change at our clinics. While I do measure DAS28, others find it cumbersome. The RAPID3 provided a simple measure, generated by patients. What we like is that it can generate a different line of conversation. "Oh, you’re having difficulty turning the tap?" "I didn’t realise you’re not sleeping well."
I gave up the tie and jacket soon after I started as a consultant in 2004. The paraphernalia did not stop the fact that patients kept thinking I was too young to be a specialist. So, I just told them that I was very bright and got through all my exams very quickly! Think Doogie Howser.
But, others in my clinic (Herman Lau, nudge, nudge) belief that the suit and tie are expected of specialists. It’s the uniform. Perception counts.
By the way, the post points you towards our Dr photos. They’ve been updated since that post, with suit & tie!
I have to thank Barry for his suggestion to write about this. Read the comments following the post. I’ll admit I still don’t bring this subject up myself but I’m glad other rheumatologists do (eg Dr Ingrid Hutton).
I’ve only become more aware of this in recent years. Working in a team with exercise physiologists and dieticians, a few of our patients on TNF inhibitors still find it hard to get rid of some of the excess weight. It affects a small proportion of patients using these drugs but which patients, how and why, remains unclear.
I indulged myself with this. I loved superhero comics growing up and still pick them up from time to time. It’s a call to action to my fellow rheumatologists and to myself.
Unfortunately, some people get seduced by the concept that “natural” therapies are much better than medical solutions (i.e. medication). It’s not so natural to pop multiple tablets and capsules filled with oils, herbs, ground cartilage, etc. And yet, these same patients often forget the BIG 3.
I needed some way to try and explain our love/hate relationship with corticosteroids. These medications are really so useful and it’s highly unlikely we’ll stop needing or using them.
More and more rheumatologists are using ultrasound as part of their clinical practice. There are multiple barriers to this, including costs and poor access to training, and when these are overcome, ultrasound becomes a very useful tool for rheumatologists and their patients. I thought it worth explaining why.
This debate is not going away anytime soon. I wrote “If both were similarly priced, I don’t think we’d be having this debate. I’m guessing most rheumatologists would choose the biologic/Methotrexate combo”. You may disagree. It makes for interesting discussion.
Over 100 blog posts this year. Thanks again for your support!
Please keep those comments coming and I hope I can keep it up in 2014.Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.