Rheumatology is putting on a new face, at least in this province. Statistics from our rheumatology association suggest that the average rheumatologist is a fifty-five year old man. (Unpublished statistics would show that he is balding and grey but nonetheless ruggedly handsome) Not for long. Most of the trainees over the last five to ten years have been women and the wave continues to wash away the remnants of maleness in the field. There has to be many reasons for this mad rush to join the poorest paid specialty in internal medicine but I suspect that one important one is that rheumatology actually allows for some semblance of a family life. Call is often from home, not that hectic, and most patients can be handled by the ER staff while you finish up supper and beddy-byes. Men would obviously benefit from these practice bonuses as well, I thrived on them, but I still think that women MD's might take these considerations a little more seriously. In this light, I would like to recommend to the many new female rheumatologists with an interest in doctor-mother issues to visit Mothers In Medicine, a multi-author blog discussing all things related to moms in medicine.
Pharmaceutical consulting/advisory meetings are a different breed of meeting. MDs are paid for their opinion concerning a product and so the agenda of the meeting has absolutely no pretense of objectivity. For the same reason, the speakers don't have to be impartial at all, and can spew out just about anything that the crowd will take. Because the members are paid, they can usually take a lot. It's at these meetings that members are sometimes put in somewhat awkward spots, being pressed to express an opinion in front of their peers, and before a paying host. Rarely, however, does it get as bizarre as the invitation that I recently received from a pharma company of one of the biologics. In their invitation I was asked to fill a questionnaire about my feelings concerning the efficacy of the major biological anti-rheumatic drugs and their side effect profile. They then asked me to "find a picture from a magazine that I thought symbolized their product, and bring it to the meeting". It might have been worth going to the meeting just to see a dozen adults doing show and tell with their favorite magazine pictures. Hope somebody brought a camera.
Our hospital is a busy one, apparently the second busiest in this large province. Our emergency is constantly under pressure and for this reason we often have patients on gurneys in the corridor. So often, in fact, that these beds now have permanent curtains. Unlike "those" hospitals, though, we don't have permanent numbers above the beds, simply cardboard and felt pen. This can't be forever, right? All the corridor beds were occupied when I visited a patient last week because of an acute ankle arthritis. A lovely women, but an ugly limb. It was obvious a joint tap would have to be done and I knew it would be difficult. Lots of swelling in a joint that is often tough to aspirate, and the patient was extremely anxious. No matter how much xylocaine you use, a really anxious patient is going to feel pain. As I had guessed, the freezing did nothing and the patient let out a little yelp of pain. What happened next, however, I could not have guessed.
The internist who had called me about the patient was nearby. He dropped what he was doing, came over and started to talk to the patient to distract her while I continued. A couple of minutes only, but for a busy hospitalist, minutes don't come easily . I finished up and while I did my notes, I noticed that an orderly had followed in behind me to help console the still teary women. He stayed a few minutes and then carried on with his many duties. As I left, I went to see that the patient was okay. In front of me, a nurse who was simply passing by gave the patient a little rub on the shoulder as she continued on.
Conclusion: Limited available comparative evidence does not support one monotherapy over another for adults with rheumatoid arthritis. Although combination therapy is more effective for patients whose monotherapy fails, the evidence is insufficient to draw firm conclusions about whether one combination or treatment strategy is better than another or is the best treatment for early rheumatoid arthritis.