The Dreaded 1st day back to rheumatology clinic post-hols

Guess which city?

Guess which city?

By Dr Irwin Lim, Rheumatologist

3 weeks overseas with my family. 3 junior school children. Almost every minute of every day together.

Time to return to work!

It’s the longest break I’ve had since commencing private practice a decade ago. Holidays are crucial to refresh and to refill the rheumatologist’s compassion quota so I definitely plan to take more this year!

However, I’m usually very wary of what I’ll return to. I think my colleagues are the same. The work builds up, problems fester, people get sicker during this time away.

The 1st day back in clinic can be very painful!

I thought you might be interested in strategies I use to cope with this:

  • Work closely with other rheumatologists. My mates can help field calls and see my patients urgently while I’m away.
  • Have reception staff with good common sense. Reception staff need to triage messages from patients and help redirect the urgent ones rather than having patients wait till I return.
  • I accept and answer emails from staff and patients on holiday. My wife does not like this. But I find that I can relatively quickly and easily sort out little problems, and redirect more urgent ones.
  • I used to check patient results while away by remotely logging into our servers. Yes, I’m type A. I’ve learned to stop this habit and have relied on staff flagging urgent results which in turn have been flagged by pathology providers, etc.
  • The afternoon/night before returning to the 1st clinic is however spent, sitting with my laptop at home, going through all these results. 3 weeks away meant a few hundred pathology test results to review. Rheumatologists tend to have lots of these given the medications we use and the requirement for regular monitoring blood tests.
  • I arrive at least an hour before clinic begins. The usual mound of mail needs reading, sorting and attending to.
  • The 1st day tends to be longer with any break spent returning phone messages and attending to lists of various tasks.

The above steps help me nip problems in the bud and help make the 1st day back after holidays more pleasant.

I’d be interested to know what my rheumatology colleagues do but I assume they have developed similar coping mechanisms.

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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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.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
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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:
Enter your email address:
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