Although as a medical student rheumatology was always associated with an air of mystery and complexity to me – factors which might have aroused a younger me had they been associated with a member of the opposite sex – the specialty didn’t catch my eye at all as an undergraduate. To a medical student cruising for medical action in the 1980′s, rheumatology wouldn’t have got as far as a first date.
Some medical specialties are cooler and sexier than others. Rheumatology could never really compete with the macho surgical cool of heading down to theatre to sew a hand back on, performing open heart sugery or with the laid back anaesthetic cool of medically paralyzing someone, stopping their heart and lungs and then starting them up all over again (while reading the paper). Rheumatologists just didn’t wear leather jackets.
At that time, and despite its best efforts, my chosen specialty had an image problem.This wasn’t the fault of the rheumatologists; we just didn’t yet have the effective tools at our disposal to significantly impact on many of the disease we treated. Nonetheless this affected the attractiveness of our specialty to those choosing a career in hospital medicine and to our colleagues in other specialties. Rheumatologists were seen by their colleagues as a specialists who provided a babysitting service, albeit with lots of steroids, to the chronically unwell. Our clinics were full of struggling patients for whom the treatments didn’t work and there were even special clinics to deal with side effects to the drugs we were prescribing (‘Gold clinics’ were not as glamourous as they sound).
With my heart set on a career in the rapidly evolving, hi-tech and terrifically sexy specialty of radiology, I decided to get some general medicine under my belt before going for the interviews. Accidentally stumbling into a few months of rheumatology as part of one of the jobs, I surprised myself by beginning to like the job. If I’m honest, the first thing I liked about it was that it seemed like a bit of a doss. In my first few weeks that summer I found myself regularly clipping my on-call bleep to the net of the hospital tennis courts to hit a few balls with another member of the team waiting for ‘something to happen’. Although it was a false dawn (the job became much busier in the following weeks), I allowed myself to imagine a a job which allowed a life outside medicine.
I liked the rheumatologists too. Most seemed to be very down to earth and have a genuine interest in the lives of the people they cared for. It seemed to be a specialty there was at least some stuff could wait ’til the morning. This allowed a measured commitment to the workplace in those I worked with that seemed to leave room for time with family, friends and for non-medical interests. Although rheumatology is not as well paid as some other specialties, I resigned myself to the certainty that if were to become a rheumatologist that I’d never own a Porsche. But then neither would I have to drive it into A+E in the middle of the night to unblock someones coronary arteries.
Rheumatologists also seemed to have a level of familiarity with their patients that I might have imagined an older rural family doctor might have, effortlessly blending the catch up familiarity of a chat between old friends with the medical business of dose adjustments, joint injections and referrals to orthopaedics. Whereas I now know that this approach and those relationships can take many years to develop, it liked its feel.
I liked the mix of clinical problems coming along to the clinic; in a single morning you could see a patients with tennis elbow, rheumatoid arthritis, gout, osteoporosis, osteoarthritis, vasculitis, lupus and even a few of the worried well. There was a nice mix of clinical medicine (where most of the clues are there from listening and examining), a bit of hi-tech imaging (with MRI, Nuclear Medicine) and a bit of nerdy hardcore science and immunology thrown in. Most of all though, I liked the patients.
Rheumatology patients are an amazingly resilient, patient and forgiving group of people. They are often cheerfully resilient while coping with the ravages and disappointments of living with a chronic disease, patient in their wait for slow acting treatments to work (and where our clinics run behind!). They forgive rheumatologists when initial attempts to treat their disease fail (we’ve got to sometimes chop and change til we get the right cocktail for every patient) but always express gratitude when things go well.
Thankfully rheumatology is entering a new era. The vast majority of patients with rheumatoid arthritis will do very well on treatment. The impact that modern treatments have had on joint damage means that for most patients, joint deformities are rare of and as result referrals to orthopedics and plastic surgery have dropped. Outcomes from sometimes fatal connective tissue disease like vasculitis and lupus have improved dramatically and we are now very good at treating gout, osteoporosis and getting better with chronic pain management.
Although I always thought that rheumatologists had reason to feel good about their role in the lives of their patients and their place in medicine, I think it is about time we added a little swagger to our ward rounds. I think I might just pop out and buy myself a leather jacket…..
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When Rheumatology Is Sexy | Don't miss this! | Rheumatoid Arthritis Warrior
[...] If medicine can be sexy the way a new car or an iPhone is, what about rheumatology? Is there ...
Very well written, as a dutch rheumatologist I recognise this almost as if it was a personal blog of my own ;-) Well done, and keep blogging!
We should all get leather jackets really. On the inside anyway…
Great article. Thank you for choosing to help all those with RA like me. It’s time for patients to get a little swagger and put the sexy back into rheumatology too. I think a bunch of us – Docs, young RA, lupus etc patients need to do a photo shoot together & show the world rheumatology changes lives and gives us hope and that arthritis is not an old person’s disease. Swagger up, grab the leather jacket, high heels & rock on. Visions of a Times Square billboard. Any takers?
love it, could you put your considerable skills to help me put a positive spin on the long waiting lists.
This is a great post and a positive overall historical view which is appreciated by a newbie. I definitely think you should get a leather jacket. But give the multiple divorces (as per surgeons putting a alimony hole in their Ferrari find) a miss. You picked the right speciality!!!
Completely true, Ronan….
By the looks of it, Rheumatology is definitely not as glamorous as cardiology/ Surgery. But, then it is still very sexy. It’s mystical & the joy seeing a patient with chronic pain do well is very rewarding.
There have been major advances in recent times & this (as you have pointed out) has traslated into better prognosis for RAaers. The number of patients with deformities & going for knee replacement have gone down significantly in the last few years.
We should all get a leather jacket asap & may be that’ll inspire many others to join the gang!
Let’s really do this. Leather jackets, Harley Davidson’s, high heels & a gang of RA people.
We can start a movement. It’s time!
Direct message me on twitter KarenAger
Good stuff Ronan. Funny enough I’ve been referred to *I think* a Dr. Coughlan in UCHG, but I’m not actually sure why. I’ve been under The Pain Clinic @ UCHG and I remember discussing with my consultant. but now I can’t remember what the thinking was behind it. I guess I’ll find out soon enough eh! :) Best wishes and love to the family, Bella (Grandi) x
It is true, rheumatology is unglamorous, contrary to the neurosurgery or cardiology. Even, dare I say that many colleagues do not know for sure that it is rheumatology. For most people we are a shaman type of doctors who treat eldery people with aches and magically cured thanks to vaccines (or at least so called monoclonal antibodies by patients in Venezuela and some doctors also …. . funny is not it?). However, you have reported all the advantages of being a rheumatologist in the last twenty years where scientific advances have put us in the forefront of medicine. Maybewe are not possess the fame or money but we have prestige. I had the opportunity to hear a conference from you long ago in Latin America, must say that I love your blog, congratulations. By the other side, I Think that Twitter is a excelent comunication toll between doctors and patients, the social network here to stay, literally. Excuse me, the englisn is not my primary lenguage.
Thanks Josmar. Hope you’ve got a leather jacket too….
Ronan, forget the leather jacket, for serious sexiness just join a rock band…. oh I forgot!
Ronan,
Superb post, and I see it has now appeared in The Rheumatologist stateside! That Volvo reminds me of Stanley Roberts’ favouite car – not nearly as sexy as the cars parked outside the Orthopaedic department!
You are setting a high standard for medical blogging – keep it up!
Philip
You were pretty handy at nephrology too Ronan, but then the medicine of wee was probably in the select group of specialties even less sexy than rheumyholiday back in the day! Along with chemical pathology :) Glad to hear you are enjoying your work- your patients are lucky you decided that having a Porsche did not compensate for having to do orthopaedics! Any trips to Belfast planned? Love to see you. Cx PS I cannot get into Twitter, am much better at Facebook.
Very funny and well written. It is nice to know our doctors care about us and think we are just as cool as we think they are.