From an Indian parable dated from before 500 BCE:
A group of blind men heard that a strange animal, called an elephant, had been brought to the town, but none of them were aware of its shape and form. Out of curiosity, they said: “We must inspect and know it by touch, of which we are capable.” So, they sought it out, and when they found it they groped about it. …
Having more doctors to assess rare, multi-system illnesses
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“When Lauren came to my office as a 16-year-old, she had been diagnosed with postural orthostatic tachycardia syndrome (POTS) and a few other chronic illnesses. By the end of the appointment, she left with a diagnosis of …
If you can’t connect the issues, think connective tissues [PODCAST]
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“ME/CFS is a complex multi-system illness that destroys lives (essentially killing the person yet leaving them alive). It leaves patients with unimaginable fatigue, post-exertional malaise (meaning that minor exertion makes them feel worse), cognitive deficits, cardiovascular dysfunction, …
Myalgic encephalomyelitis/chronic fatigue syndrome and long COVID [PODCAST]
Medical school, residency, and fellowship taught me pathophysiology, diagnosis, and the most advanced treatments for autoimmune diseases like rheumatoid arthritis. As an attending physician, seeing my own patients, I noticed that targeted therapy is not able to control the disease in all patients with rheumatoid arthritis. The results varied. I could not stop asking myself, why is it so different?
In my previous article, I wrote about one of my patient’s …
Focus on the rheumatoid arthritis patient, not on their disease
At her Supreme Court confirmation hearing in front of the Senate Judiciary Committee, Judge Ketanji Brown Jackson recounted a story from her time as a college undergraduate. She recalled being a freshman at Harvard after having attended public school in Miami, Florida, and her transition to life at the university had been challenging, causing her to question if she belonged at the school and if she could succeed. She was …
Five years ago, I met a patient that changed my view on practicing traditional medicine, especially when it comes to rheumatology. For years, I was proud to be in a booming field that provided patients with a new therapy every few years. As a physician and scientist, I believe that targeted therapy offers tools to treat patients like never before, but I have noticed that results vary over time.
Daniel was …
The role of nutrition in rheumatology patients
“If your shoulder were really injured, that maneuver would make you scream in pain,” he told me confidently.
My husband and I recently established care with a new family doctor. I was frightened and scarred from a long history of medical gaslighting that still tightens my throat whenever I meet a new physician.
Will this doctor believe me? Will he understand?
Years of dismissal made me wary of a new start, but we …
What a lifetime of gaslighting by other doctors feels like
Three years ago, I was a physician in the “traditional” medical system seeing 25 to 28 patients every day. I spent hours writing notes to provide proper documentation for the correct billing code. Often, my time was spent calling insurance companies to justify the appropriateness of my medical care. More and more hours were spent on completing tasks for insurance companies rather than patient care. Like many of my colleagues, …
10 steps to create your direct specialty care clinic
Yet again, while reading an article about fibromyalgia, I was hit with another pejorative term in the first few lines. The authors describe the usual characteristics of fibromyalgia and then say, “and a high level of catastrophizing related to pain.”
If you do a Google search for “catastrophizing,” it tells you that it is “a way of thinking that assumes things are worse than they are or will have a far …
Fibromyalgia is not a trash can diagnosis
Joint pain, nausea, dizziness, bloating, palpitations, urticaria, headache, and fatigue. Surely this must be a list of the chief concerns for each of your first eight patients for the day.
No, these chief concerns all belong to your very first patient of the day. A new patient is scheduled for a 20-minute slot.
How will you possibly get out of the room in time? How can you ever help this young woman? …
As a clinician, you likely do not have the luxury of playing “Dr. House.” Patients enter your exam room, long story in hand, with a litany of mysterious symptoms involving every bodily system, and you were already massively overbooked. Your patient leaves the encounter no closer to answers despite your best attempts which involved you spending far more time on their assessment than your crazy office schedule allows.
Your staff becomes …
The journey to diagnosing a mysterious illness
The new reality of medical conferences shaped by the COVID-19 pandemic requires a new language and a fundamental rethink to make these major showcases of medical organizations and societies a place where physicians and patients can share their experiences and perspectives.
We can no longer characterize medical conferences as – in the words of an old Jimmy Buffet tune – “a Holiday Inn full of surgeons” who meet there every year …
Beyond Jimmy Buffet: The new medical conference
One day, a primary care physician located about two hours away called my office in a desperate attempt to find a rheumatologist. His lovely 64-year-old patient, very healthy otherwise, recently developed a severe and disabling inflammatory arthritis. After conservative treatments failed, he tried to refer the patient to the traditional medical system. However, they could not get a sooner than six months appointment. This is a symptom of a broken …
The emergence of direct specialty care
“The symptoms of EDS aren’t limited to the musculoskeletal system and commonly affect everything from hearing and vision to integumentary issues such as prolonged wound healing and easy bruising. It also became apparent that the specialists I had seen had contributed valuable information to the overall puzzle but were simply not able …
What you need to know about Ehlers-Danlos syndrome patients [PODCAST]
I’m “blursed.” I have a loving and supportive family, an amazing wife, great friends, and that includes my dog, a career that is both secure and fulfilling, and yet there is something I carry with me that perpetually threatens to break my spirit. My fellow Reddit fans/addicts know the meaning of “blursed,” but for those that don’t, it’s one of my favorite portmanteaus – it means to be both “blessed” …
How this doctor deals with the F-word (fibromyalgia)
Embarrassment is a feeling of awkward self-consciousness or shame. It manifests as a sense of discomfort or even foolishness around others. Feeling embarrassed is emotionally painful because it means you feel uncomfortable with yourself.
The problem with embarrassment is that it adds a layer of mental suffering to the difficulties you’re already facing with your health. Here are four reasons why those of us who are chronically ill feel embarrassed at …
What to do when chronic illness is a source of embarrassment
Australian singer/songwriter Sia (born Sia Kate Isobelle Furler), 43, is known for wearing elaborate wigs and headpieces that hide her face. However, the “Chandelier” singer is not hiding the fact that she was recently diagnosed with the connective tissue disorder Ehlers-Danlos syndrome.
“Hey, I’m suffering with chronic pain, a …
Physicians explain Sia’s chronic pain
Reality star and meta-celebrity Kim Kardashian West made the rounds on the network news and talk shows last week to promote her new line of shapewear. But she also talked about the recent health scare that was revealed on the latest episode of “Keeping Up with the Kardashians.”
Talking to Savannah Guthrie and Hoda Kotb on Today, …
The mystery illness of Kim Kardashian West
“The Big Sick” is an intimidating name for a movie. I never know what to think when “sick” is used as a noun. Does it mean vomit? Are we referring to ailing people? Just as the name doesn’t give you much insight, neither does the beginning of the film. It has nothing to do with illness. It’s about a Pakistani standup comedian/Uber driver who starts dating a white girl, but …
What The Big Sick says about our profession
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 23-year-old woman is evaluated for 2 weeks of painful lumps on her legs. The lumps persist for several days and make it difficult for her to go to work as a waitress. She is a college student in Ohio where she has lived her whole life. She has …
MKSAP: 23-year-old woman with painful lumps on her legs
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