Sharing a podium with Jessica Gottlieb
By Dr Irwin Lim, Rheumatologist
On Monday, I was given the chance to share the stage with Jessica Gottlieb (http://jessicagottlieb.com) . Jessica’s a noted “mommy blogger”, residing in LA.
She flew in to Perth to speak at our Australian Rheumatology Association, at a symposium on Social Media. It’s a first for our association and I was quite surprised that the room was filled with over 150 rheumatology health professionals.
I’m sure some in the room have never read a blog. I’m certain many didn’t really know what a tweet involved. But they still came.
Jessica has rheumatoid arthritis. Her brief was to explain how and where online a patient given that diagnosis would try to get more information and support.
By all accounts, her rheumatologist is excellent, and she’s happy with the relationship. And I’m sure that’s true for many patients. But, it remains common for people/patients to supplement this relationship with search on-line. To ask Dr Google, to ask their followers or facebook friends and any variety of online communities/forums. Sometimes the advice isn’t that good.
Jessica made all this clear.
What impressed me most about Jessica?
She has a very large online audience and this gives her a powerful reach. What she tweets/posts/writes influences. How she uses this clout matters.
She blogs about many different aspects of her life, including living with a chronic illness. She’s used her influence to provide support. She reports what she feels and what she experiences, warts and all. Sometimes she vents, sometimes she just gets on with life.
She’s actually resisted providing online medical advice. She instead tells people it’s crucial to find a good rheumatologist to work with. That doesn’t stop her sharing her experience & her compassion when her readers reach out.
I like that. I know I’m biased as a rheumatologist but it’s an approach that’s gentle and supportive, and helpful to the rheumatology community.
My talk followed and my brief was to explain to the gathered why rheumatologists should consider joining the online conversation.
I talked about what actually made me start blogging (my 1st post) after being someone who shunned social media.
I discussed the fears that I had because I thought many in the room would have similar fears (bravery is a prerequisite).
By using this platform, by engaging with a community that wants more physicians online, by helping moderate and providing balance to some of the what is written/tweeted/posted online, I told the audience that I believed I’d become a better, more effective doctor.
Our symposium was (to my relief) well received. I know some have been convinced to take their 1st steps and I know a few will be reading this.
I’m already aware of a few changes:
- Sadly, @samwhittle (follow him here) changed his buffed twitter profile photo after being highlighted in my talk, much to the dismay of his female followers.
- Some rheumatologists decided to google themselves to see what web profile they may or may not have.
- 7 attendees joined twitter and followed me! More to come hopefully.
- Another told me she was going to start a blog to help her medical students.
It’s a good start.
Thanks to Abbvie, the pharmaceutical company, that conceived this symposium.
Thanks to Jessica for helping the Aussie rheumatology community tiptoe into this space.
Won’t it be nice to see patients and more rheumatologists online, helping each other and working towards common goals?
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.Access to your Rheumatologist saves Time & Money
Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net
By Dr Irwin Lim, Rheumatologist
On Saturday, my mobile was rung by a number I didn’t recognise. A concerned family member of a patient.
The patient’s an elderly gentleman, with Giant Cell Arteritis. This is a serious condition with a very serious possible complication of sudden blindness. He’s already loss vision in one eye. The treatment in most cases is Prednisone, steroid therapy.
She rang to tell me that her uncle had developed a short episode of very sharp pain behind his good eye. This occurred as we were weaning the dose of Prednisone. They were understandably very worried.
My advice was to double the amount of steroid. She was to ring me again if he developed another episode and we arranged a consultation early in the week.
The alternative if she couldn’t reach me or the patient’s general practitioner? Remember, it’s the weekend.
Well, she would have brought her relative to the emergency department. A Saturday afternoon. Likely a wait of many hours. Tests would have been ordered. A full history would have been recounted. Depending on the senority of the attending doctor, treatment would be delayed somewhat.
The cost? Lots of time & some potential wasted health dollar.
I’ll admit that I don’t give my mobile number to all patients. But the ones I’m worried about have it. I’m contactable by email as well.
I of course want to have my weekends “patient-free” and over the years, there have only been a few patients who have abused my gesture.
The point of this post is to let you know that many doctors do this. It’s one way they try to help their patients, and to reduce load on an always stretched public health system. It’s peace of mind for the patient (and me).
And, it saves time & money.
What is your experience with needing quick access to your rheumatologist?
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.RAPID3: What we’ve noticed after 1 month in a private practice setting
By Dr Irwin Lim, Rheumatologist
Our previous posts on whether we should use patient-reported outcome measures, and in particular, the RAPID3, were well received.
If you missed them, here are the links:
Maybe what my Rheumatoid patient reports is more useful than my tests?
8 reasons why rheumatologists should collect patient self-report data in routine clinical care
At the start of April, after “negotiating” with all levels of our staff, including administration, allied health practitioners and doctors, we introduced the RAPID3 to BJC Health.
Across 3 different clinic sites. Involving the patients for the 6 rheumatologists, 7 physiotherapists and 3 exercise physiologists.
While the RAPID3 questionnaire was originally designed and validated for use in Rheumatoid Arthritis, it’s architect Ted Pincus, had shown that it has utility in many other rheumatic diseases.
BJC Health had been searching for a simple measure that we could use for all. So, we chose to apply the RAPID3 to all our musculoskeletal patients, including osteoarthritis, all inflammatory arthritis, patients with a spinal problem or a knee injury, etc.
Logistics do matter:
- When patients arrive at the clinic, they are provided by our reception staff the 1-page RAPID3 to fill. This takes most less than a minute but some do struggle.
- To complicate matters, other craft groups such as dermatologists practice in our clinic. Our reception staff try and avoid giving these patients the form
- The patient or the reception staff hands the completed form to the treating health professional
- The health professional scores the answers. This should take less than 10 seconds
- The health professional enters the scores into our patient’s electronic health record to enable us to track the results over time
- The patient’s answers/responses may direct the health professional to enquire about specific problems
These are some of our observations after 1 month of using the RAPID3:
- We are consuming a lot of paper.
- Patients on the whole don’t mind filling in the form and in fact, many do think it’s helpful.
- Some struggle. The font has been too small for some. Some just don’t seem to get a numeric scale.
- As expected, non-native English speakers struggle and many have refused.
- Reception staff struggled initially to remember to hand out the forms especially when the waiting room became busy but this is improving.
- Health professionals didn’t enter the data into all patients’ e-health records but this is improving.
- For patients who have presented more often eg twice a week to the physiotherapist for their acute knee problem, we needed to develop a system so that they weren’t given the form twice in 1 week
- Our team is starting to see a benefit and really like that the patients have to sit and consider and then quantify their pain levels, and other measures of function. The overall score also give us a better sense of how much the condition/s is affecting the patient’s ability to live life.
- We’ve picked up issues such as sleep disturbance and patients struggling with simple daily activities. Issues we may or may not have found out about in the general flow of a consultation.
We haven’t captured every patient, every time they present to the clinic, but to date, 1297 RAPID3 questionnaires have been filled and recorded at BJC Health.
All in all, a good start. We’re looking forward to being able to discuss and show a difference over time in how patients score.
If we feel we truly help our patients, and truly make a difference to their overall quality of life, we need to see improvements in this simple measurement.
After all, does it really matter if I feel chuffed that I’ve reduced the number of swollen joints I can detect in a patient, when that same patient still reports not being able to put on their socks or still can’t return to playing tennis?
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.BJC Rheumatology Word Art
By Dr Irwin Lim, Rheumatologist
While helping my daughter with her home work, I was taught a new trick.
Word Art. Throw together a bunch of words and the site (www.wordle.net) creates a nice looking piece. I couldn’t resist so here’s my attempt.
Fathers, Brothers & Husbands do get Osteoporosis too
Colles Fracture
By Dr Irwin Lim, Rheumatologist
Blokes can often neglect their health or have their health neglected. This is the case with Osteoporosis.
Aspects of difference between the sexes were presented at the last osteoporosis meeting I attended (link), as was data confirming that the bisphosphonate medications do work in males just like they do for females.
I thought I’d highlight this bony plight of men.
First, osteoporosis is common for men, as it is for women:
- The incidence of minimal trauma (also known as osteoporotic or fragility) fractures in men is still approximately 1/3 to 1/2 that in women
- Almost 1 in 4 men aged over 60 will have an osteoporotic fracture
- By 2050, the number of hip fractures is expected to increase by 300% in men
And, it isn’t pretty when it happens:
- Morbidity & mortality of hip fractures is 3 times higher in men than it is in women!
- After the hip fracture, 50% of men do not regain their independence and mobility
Osteoporosis in men has some different causes and exacerbating factors:
- 50% of men will have Secondary Osteoporosis compared with 20-30% in women (learn more about secondary osteoporosis)
- Common factors include the use of oral steroids, low/reduced sex hormones, smoking and excessive alcohol
The good news is that there are effective, well-tolerated treatments for osteoporosis. These treatments actually help prevent an osteoporotic fracture occurring and therefore help reduce the suffering and death caused by osteoporosis.
You (and I assume you’re more likely to be female if you’re reading my blog!) just have to convince your male loved one to consider discussing osteoporosis with their doctor.
Have you had experience with this? If you’re a male with osteoporosis, I’d love to hear your story.
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.
