BJC Health’s Vision & The Sushi Train


By Dr Irwin Lim, Rheumatologist

The family’s spending New Year in Tokyo. One night, cold and hungry in Shibuya, we stumbled into this Sushi Train joint.

photo 1It was very cool. A departure from the usual procession of sushi plates going round and round the track.

We all took great delight in ordering the nigiri and norimaki we wanted on the touchpads provided. The order was sent electronically and soon after, a “carriage” rolls out and stops just in front of you. You lift your food off the carriage and then hit a button to send the carriage back into the kitchen.

photo 2A reinterpretation. Unexpected and delightful. We all enjoyed the delivery as much as the actual food.

That serves as an introduction for the main reason for this post. Our Vision Statement.

It’s 2014. I started my life as a consultant rheumatologist in 2004. If you’re a regular to this blog, you already know that I work as part of a team. A team of rheumatologists, physiotherapists, exercise physiologists, dietitians and more. Our path has meandered a little but we’ve always believed that this sort of group practice enhanced care for our patients with rheumatological problems.

We’ve been working on refining our vision over many years and actually committing it to words has proven very difficult. Our leadership team has toyed with a variety of versions and we’ve finally agreed. The wording may change in the future but I think the central theme will endure:

Our Vision

BJC Health has a vision that people suffering with arthritis deserve the best possible care.

This will be achieved through a multidisciplinary approach. We call this Connected Care.

One step to achieving this vision is creating a purpose built Arthritis Centre in Parramatta by 2016. This will set a new standard in arthritis care in Australia.

It’s a big step to commit this vision statement to print. An important reminder of what drives our leadership team, and a reminder of the shared purpose for all our staff.

What does a vision statement have to do with a sushi train?

Not much really.

Except to say that while getting from point A to point B is clearly important, we should also spend effort in making sure that how we do this, the journey, is as pleasant, as effective and as convenient as we can make it.

Patient care in rheumatology can be reinterpreted. Creating something unexpected and hopefully, delightful. A lovely vision for me to start my year.

I wish you all a Happy New Year!

Merry Xmas from the BJC team!


BJC Xmas 2013

Hope your celebrations end 2013 on a cheerful note & make way for a wonderful & exciting New Year.

Be joyful, don’t over-indulge and stay safe.

We wish  you a Merry Christmas and a Happy New Year!



My favourite rheumatology posts for 2013


By Dr Irwin Lim, Rheumatologist

This year has flown by, frighteningly quickly. I think that implies that it was busy and overall enjoyable.

Writing this blog has been an important part of my year and I’d like to thank you all for your support. It definitely keeps me going.

I’ll admit that the enthusiasm has waned in recent weeks. I’ve been feeling lazy and less motivated, the blogging has seemed hard work. The end of year holidays are needed.

I sat down yesterday to review what I’d written for the year. Here’s a selection of the posts I thought most useful or enjoyable.

Maybe what my Rheumatoid patient reports is more useful than my tests?

Listening to Professor Ted Pincus led to change at our clinics. While I do measure DAS28, others find it cumbersome. The RAPID3 provided a simple measure, generated by patients. What we like is that it can generate a different line of conversation. “Oh, you’re having difficulty turning the tap?” “I didn’t realise you’re not sleeping well.”

When you google your Rheumatologist, do you want to see Tie & Suit?

I gave up the tie and jacket soon after I started as a consultant in 2004. The paraphernalia did not stop the fact that patients kept thinking I was too young to be a specialist. So, I just told them that I was very bright and got through all my exams very quickly! Think Doogie Howser.

But, others in my clinic (Herman Lau, nudge, nudge) belief that the suit and tie are expected of specialists. It’s the uniform. Perception counts.

By the way, the post points you towards our Dr photos. They’ve been updated since that post, with suit & tie!

How does Arthritis complicate being Intimate?

I have to thank Barry for his suggestion to write about this. Read the comments following the post. I’ll admit I still don’t bring this subject up myself but I’m glad other rheumatologists do (eg Dr Ingrid Hutton).

Do TNF inhibitors make you put on weight?

I’ve only become more aware of this in recent years. Working in a team with exercise physiologists and dieticians, a few of our patients on TNF inhibitors still find it hard to get rid of some of the excess weight. It affects a small proportion of patients using these drugs but which patients, how and why, remains unclear.

Spiderman Says & Rheumatologists should listen

I indulged myself with this. I loved superhero comics growing up and still pick them up from time to time. It’s a call to action to my fellow rheumatologists and to myself.

The BIG 3 Natural therapies for Arthritis

Unfortunately, some people get seduced by the concept that “natural” therapies are much better than medical solutions (i.e. medication). It’s not so natural to pop multiple tablets and capsules filled with oils, herbs, ground cartilage, etc. And yet, these same patients often forget the BIG 3.

Dear Steroid, I love you…
Dear Steroid, I hate you…
Why Rheumatologists will continue to use Steroid

I needed some way to try and explain our love/hate relationship with corticosteroids. These medications are really so useful and it’s highly unlikely we’ll stop needing or using them.

6 reasons why Ultrasound is useful in my Rheumatology hands

More and more rheumatologists are using ultrasound as part of their clinical practice. There are multiple barriers to this, including costs and poor access to training, and when these are overcome, ultrasound becomes a very useful tool for rheumatologists and their patients. I thought it worth explaining why.

Triple Therapy vs Biologic/MTX: the debate rages
Biologic DMARDs have to get cheaper: here’s how

This debate is not going away anytime soon. I wrote “If both were similarly priced, I don’t think we’d be having this debate. I’m guessing most rheumatologists would choose the biologic/Methotrexate combo”. You may disagree. It makes for interesting discussion.

Over 100 blog posts this year. Thanks again for your support!

Please keep those comments coming and I hope I can keep it up in 2014.

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.
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Your Rheumatologist: partnership vs paternalism?

Image courtesy of photostock/

Image courtesy of photostock/

By Dr Irwin Lim, Rheumatologist

As I read patient comments on social media, I get the sense that many yearn for their rheumatologist to be a partner in navigating their disease and helping them make their treatment decisions.

Rheumatology is difficult. Much of what we treat, and especially with autoimmune arthritis, is chronic, and can have profound effects on patients lives. Treatments can be complicated and scary. We are sometimes guided by scientific evidence, sometimes by experience, and often by our sensitivity, the art of medicine.

There is no doubt that for many of my patients, we work together in coming to decisions.

There are however, equally many patients, that to my mind, do not or cannot take a more active part in their management decisions. Some find it very hard to cope with the diagnosis and rather than go out and garner information, they avoid it.

At our clinic, we have created a lot of resources, both paper-based and web-based, to help education. I haven’t formally audited it but I have the sense that it’s appreciated by some and probably unused by many.

“Doc, just tell me what to do.” “You’re the expert.”

Often, I need to be directive and the patient needs to be directed.

It might be heresy, in social media circles, to talk about being paternalistic. I don’t mean to court complaint.

It’s just that different people want and/or need different approaches. Sometimes, doctors get it wrong but most are trying to do the right thing for the people they care for.

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.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
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When is the best time to have your joint replaced?


Knee XRBy Dr Roberto Russo, Rheumatologist

The answer to the above question used to be relatively easy to answer. The standard response used to be simply: when all other treatments have failed and the risks of the operation appear less concerning than the prospect of continuing to live with the pain of the arthritis. The focus of non-surgical therapies and interventions has been to retard the progression of the disease and to assist patients with their pain in order to delay the need for surgery for as long as possible.

Whilst this approach is effective in most patients for many years, over time there emerged an increasing proportion of patients in whom these conservative strategies fail and the dilemma of when to have surgery arises.

In that circumstance many a doctor would often refer that decision to the patient, saying ‘let me know when you are ready and I will arrange the operation’.

This is probably the case because clinicians find it very difficult to appreciate on an individual basis the impact of pain and impairment on the quality of life of their patients, despite quantitative methods of measuring quality of life being used in the research arena. As a result, I suspect many a patient chooses to suffer with their pain rather than commit to making such a decision.

Sadly, it is not uncommon for a patient to delay their decision for so long that when they finally choose to have the operation they find that they have developed other health problems which prevents them from proceeding to surgery.

So should clinicians be advocating for joint replacement surgery when symptoms demand rather than leaving it to their patients?

A recent article published in the October issue of the British Journal of Medicine (reference below) adds some interesting results that I feel are worth considering when reflecting on how to address the above question. The researchers evaluated the rate of serious cardiovascular events over 3 years, including cardiac death and myocardial infarction, following joint replacement surgery (of either the hip or knee) in a population of patients with moderate-severe osteoarthritis compared to a similarly affected group who did not undergo surgery. They found that:

  • The group who had joint replacement surgery were significantly less likely to experience a serious cardiovascular event (hazard ratio 0.56, p<0.001)
  • Absolute risk reduction within 7 years was 12.4% and therefore the number needed to treat with arthroplasty to avoid a serious cardiovascular event was 8
  • The significant risk reduction was independent of traditional cardiovascular risk factors.

Therefore, the conclusion of the paper was that primary joint arthroplasty has a cardioprotective benefit in patients with moderate-severe osteoarthritis of the hip or knee. This is reported to be the first time such an effect has been demonstrated.

The reasons that are presented to explain the findings include:

  • Physical activity increases following surgery
  • Reduction in pain leads to a reduced need for NSAID use and less psychological distress, both of which are thought to increase cardiovascular risk

These results, if replicated by larger longer term studies, would suggest that elective joint replacement surgery should be a term of the past.

Instead the decision to proceed to surgery once conservative therapies have failed is a recommendation made on the balance of health benefits (including a reduction in cardiovascular disease risk) to the short and long term risks of the procedure.


1. Ravi B, Croxford R, Austin PC, et al. The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis. BMJ 2013; 347: f6187 doi: 10.1136/bmj.f6187

Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
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