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Prague Rheuminations 1

By Dr Irwin Lim, Rheumatologist

I’ve been away at an immunology summit in Prague. 500 rheumatologists, a bevy of good speakers, 3 days of “rheum”-inating.

A meeting proves worthwhile for me if I can bring back an idea or two that changes my clinical practice and improves patient care. This was.

After a bunch of talks/seminars on rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis & spondyloarthritis. I learned some good stuff. As importantly, the time away allowed me to reflect on my clinical practice and work out ways to improve.

Distance may make the heart grow fonder but in my case, being out of sight, helps sharpen the mind.

Prague is an enjoyable place to be and I had a day and a bit to explore. I thought I’d share some snapshots. The city is beautiful and a nice place to walk around, especially as it takes longer to get around by car than by foot.

This was good exercise and helps counter Czech food.

Lot of meat. Pork everywhere. This are some of what I ate.

Then, there’s the beer. I drink very little usually but being in Prague, I had to do my bit to sample the local amber. It was good and ridiculously cheap. Cheaper than water or Coke.

I couldn’t help wondering as I feasted on the above diet about Czech arthritis. While I was being lectured about various inflammatory arthritis, what about the most common inflammatory arthritis in the world – gout?

Surely, this great beer and food would do wonders for serum urate.

Anyway, I’m back in Sydney and back to the clinic. I started measuring DAS28 more regularly in my rheumatoid arthritis patients and am ready to start using the AS-DAS to monitor my spondyloarthritis patients. I’m a little more confident in interpreting spondylitis changes in MRI and my notes of immunology pathways have been reread.

Time to start planning that next conference.

Dr Irwin Lim is a rheumatologist and a director of BJC Health.
Arthritis requires an integrated approach. We call this, Connected Care.  Contact us.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.
 
 
 
Posted on: 03-18-2012
Posted in: Rheumatology

So, I’m your 4th rheumatologist? 7

A 6yo's interpretationBy Dr Irwin Lim, Rheumatologist

Not infrequently, I see a patient who’s after another opinion. Sometimes, it’s after years of seeing other rheumatologists. Sometimes, I’m not even their 2nd rheumatologist or their 3rd. I’ve been 5th choice on a number of occasions.

These consultations are always tricky and not something I look forward to.

The early thought would usually be: Is it them or us?

Sometimes, it’s because the patient’s symptoms and complaints can’t be worked out. A clear diagnosis may not be possible and discontent leads to more doctors and more opinions. This may be unavoidable.

Perhaps, it’s because the patient is “difficult”. He or she may not be able to accept their disease or they may not want the options as presented. Us doctors like to use this term, “difficult”.

Perhaps, it’s us. My colleagues may not have listened enough or asked the correct questions. Maybe we should have tried to marry our clinical goals with the needs of the patient in front of us.

I think that often it’s just a case of poor fit. I don’t get along with every patient & I know that my style would probably not work for a number of people. Must be the same for my colleagues.

By the way, I’m not offering that as an excuse not to try harder.

Dr Irwin Lim is a rheumatologist and a director of BJC Health.
Arthritis requires an integrated approach. We call this, Connected Care.  Contact us.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.
 
Posted on: 01-17-2012
Posted in: Rheumatology, The Medical Profession

Reflecting on a year of rheumatology blogging 7

A 6yo's interpretationBy Dr Irwin Lim, Rheumatologist

A year ago, I started this blog with the question “Why bother blogging?“.

Over 100 posts later, I think I have a better answer but it’s taken time to develop that realisation.

Like other doctors contemplating social media, I had a number of fears which I wrote about in “why bravery is a prerequisite to start a blog“.

Fear 1: Exposing myself to the public

Fear 2: What if people don’t find what I write interesting or useful?

Fear 3: What if someone makes negative comments?

Fear 4: What would my medical colleagues think?

Over 100 posts later, I’m glad to report that these fears are no longer such an issue.

Of course, I think about what I write and I’m careful what I tweet but this caution doesn’t stop me from expressing a view. I’m glad to have received enough feedback to suggest that people actually read this stuff. Some even leave a comment (please do!) and I’ve even found some new colleagues & collaborators through this medium.

Luckily, negative comments have not been an issue. My medical colleagues? Well, I think the responses range from indifference to uneasiness. I wasn’t really looking for congratulations which is a good thing, because that’s been few and far between.

All this has helped answer “Why bother blogging?”

Well, I now blog because I think it makes a difference.

There are only a handful of rheumatologists worldwide who bother. I am not aware of any other Australian rheumatology practice that bothers. This is a shame given our specialty suffers from a general lack of profile. People don’t know what rheumatologists do and what we are capable of. And this is to the detriment of the many people who suffer from arthritis & musculoskeletal disease. People/patients who typically get delayed diagnoses, who are not given appropriate treatment, or who have their disease trivialised.

I write to educate, to raise awareness, to entertain, and sometimes, to make a point.

Often, I learn something about something, &  sometimes, something about myself as I write this rheumatology blog.

Dr Irwin Lim is a rheumatologist and a director of BJC Health.

Arthritis requires an integrated approach. We call this, Connected Care.  Contact us.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.


Posted on: 12-14-2011
Posted in: Rheumatology, Social Media & Communication

Connecting Rheumatology Care 0

Reception at our Parramatta rooms

By Dr Irwin Lim, Rheumatologist

On Sunday, I gave a short presentation at the Australian Rheumatology Association‘s NSW Branch meeting.

I spoke about our clinic and BJC Health’s 8 year journey in trying to establish an Integrated Rheumatology service. We’ve had a bumpy journey, learning and improving after mistakes and misadventures, but we’ve now grown to have over 30 staff and contractors over 3 locations.

We now run a rheumatology service unique in the state of NSW, and as far as I know, in Australia. We have a larger team than any rheumatology department in any teaching hospital in NSW.

I believe every rheumatologist in that room would have agreed with the goal of Integrated Rheumatology care. The problem is that it’s very hard to deliver! Some deterrents include:

Gym area within our clinic

  • it’s expensive to set up
  • it’s hard to make financially viable
  • it’s hard to find like-minded people to work together
  • it’s hard to create the right team
  • it requires a lot of effort and time to run & improve

It’s definitely been hard work but we strongly believe that for patients with chronic rheumatic disease, optimum care can only be delivered by a coordinated, multi-disciplinary service. No one allied health professional or doctor can reasonably meet all the needs of the patient. It makes sense to team up health professionals in the same location for added convenience. This then translates to improved patient compliance and improved communication between the team members.

At BJC Health, we call this approach, Connected Care. Connected Care for better patient outcomes.

On one of my slides, I raised the question “Why Bother?”

The final word on this will go to RA Guy:

“ When you live with a chronic illness like rheumatoid arthritis, going to all of your different health care appointments can easily feel like a full time job. And to make the situation even more complicated, everything is usually in a different place. You have to go one place to see your rheumatologist, another place to get physical therapy, another place to exercise, another place to get your lab work done, another place to see your psychologist, and so on, and so on.

As I commute from one place to another day after day, I often start to daydream. Wouldn’t it be nice to have all of these services in one place? “

Do you agree?

Dr Irwin Lim is a rheumatologist and a director of BJC Health.

BJC Health provides a connected care multidisciplinary team philosophy to deliver positive lifestyle outcomes through a holistic approach to those with degenerative & inflammatory arthritis, tendon injury and lifestyle diseases. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.

 

 

Posted on: 11-24-2011
Posted in: Connected Care, Rheumatology

Chicago: my ACR 2011 1

By Dr Irwin Lim, Rheumatologist

Chicago took about 20 hours of flying time to reach from Sydney, covering a distance of 9240 miles. It’s been worthwhile.

The 1st day on ground was a beautiful, sunny day. It was my day of sightseeing prior to the infusion of rheumatology: Millenium Park, the Art Institute, the Sears/Willis Tower (America’s tallest building) and an architectural tour along the river.

The next day, the weather turned. Much colder, wetter. Perfect for being in a convention centre. ACR 2011 attracted over 16,000 delegates. All aspects of rheumatology were covered: basic science and clinical, degenerative and inflammatory conditions, the common and the obscure. It’s impossible not to be stimulated in such an environment.

Some sessions I attended discussed:

  • Small molecules, targeting JAK & SyK in rheumatoid arthritis
  • Antimalarials, such as Hydroxychloroquine – history, current use & future directions
  • T2T – the emphasis on treating to target in rheumatoid arthritis
  • MRI imaging & TNF inhibition in Ankylosing Spondylitis
  • The use of TNF inhibitors in Axial Spondyloarthritis
  • “Did you brush your teeth today?”  - looking at the association between periodontal disease and autoimmune disease
  • Gout: new directions for this most common inflammatory arthritis
  • Coeliac Disease: an update
  • Vitamin D and Calcium – discussing the calcium controversy
  • Biosimilars and the difficulty in bringing biologic “generics” to market

At other ACRs, the jet lag always hobbled me. This time was better as I had 1 full day prior to my conference start to help reset the body clock.

In addition, I brought my iPad with a bluetooth keyboard attached. Wonderful for taking notes. This helped keep me awake and allowed me to even contribute to the meeting’s twitter conversation (#ACR2011 for those tweeps reading).

All in all, good fun and food for the brain.

Dr Irwin Lim is a rheumatologist and a director of BJC Health.

BJC Health provides a connected care multidisciplinary team philosophy to deliver positive lifestyle outcomes through a holistic approach to those with degenerative & inflammatory arthritis, tendon injury and lifestyle diseases. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.

 

Posted on: 11-11-2011
Posted in: Rheumatology
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