October 2011

Off to the 2011 ACR meeting

Three days to go until my mom and I board the Cincinnati Megabus heading for Chicago. Mom turned 80 yesterday, so this trip will be part of her birthday festivities.

I try to attend the American College of Rheumatology's annual meeting to keep up with new medical research and developments, and with changes in the ever-expanding regulations and requirements for running a medical practice.

This year I'll go a day early to take a board-recertification course (rheumatologists have to recertify every 10 years), so there's a good chance I'll get burnt out before the conference ends a week later. Which means...Mom and I may end of doing some shopping on the Magnificent Mile, and I'm sure we'll try out a little deep dish pizza.

Stay tuned for updates from the conference.

Prop Open that Back Door

You may already know, Reader, that Dr. Fritz's office has a back door. That glass door leads directly from the office to a field of grass, and almost 20 years ago, it was one of the deciding factors in Dr. Fritz's decision to lease this particular office space. When the architect was called to build the space out, that back door received a lot of attention...frankly, most of the way the office works hinges (a pun!) on the back door. It lets the light in. It lets the doctor out. 

In good weather, you will probably find the back door propped open and Dr. Fritz sitting (or lying) in the grass in the sun. That's where she often dictates her patient notes. It's where she reads patient charts and where she rests. It's where she daydreams. It's one reason her patients see her as so relaxed and happy (and tan).

I guess everyone needs a back door. 

A Rheumatologist Wrestles to Keep her Patients First

Navigating the maze of managing and maintaining a medical practice today is increasingly difficult. Often, I wish that on any given day I could see my patients, collect a reasonable amount of money for my service, pay my staff and myself, and go home. But practicing medicine has become much more complex than that. Between insurance hassles, demands for medical offices to become "paperless," decreasing reimbursement rates, and multitudes of forms to fill out for essentially everything, the challenge to stay focused on patient care escalates.

I love taking care of patients. And I actually love the business end of practicing medicine. That is why I continue to have a solo, subspecialty practice after 25 years. But I must admit that I didn't anticipate so much change in how I practice medicine at this point in my career. So now I look forward to tackling the new hurdles of being a self-employed doctor as I continue to connect with and hopefully help the person who sits in front of me---even if a computer sits between us.

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I'll Hold Your Arthritic Hand even if You Can't Hold Mine

Renoir, Aline, and Coco, 1912Renoir, Aline, and Coco, 1912At the time of Dr. Fritz's first visit with her patients, she explores their social histories. Taking a comprehensive social history is a critical part of being a good physician. Why? Because social histories—family relationships, social relationships, work, hobbies, pets, activities, exercise, habits, etc—tell physicians a lot about their patients; social histories are a window into patients' presenting problems and offer a glimpse into the structures that will support the suggested treatments. 

That's what I think about when I gaze upon this image of the French impressionist Auguste Renoir and his friends. I mean, look how frail he is as a result of the limited treatments available for Rheumatoid Arthritis in the early 1900s—Renior is slumped back in his chair, his feet are bound in braces in an attempt to slow their deforming, his hands are gnarled. 

And yet he has these very nice people with him. 

I like to explore the body language in this image...first of all, I like it that they're all outside in the fresh air together. Both the child and the woman lean in toward the artist...it's not, however, as if they're propping him up. I get the feeling they simply gravitate to him. They gaze in his direction, and they're both smiling at Renior rather than at the camera. Nice. And the child wears a hat exactly like Renoir's hat! Seriously, that's love, isn't it? And the ample woman in the polka-dotted dress covers Renoir's knotted hand with her own wide one.

What a fortunate man Renior was—all the while he lived with Rheumatoid Arthritis, he continued to do work he loved while sitting outside in the company of young people and a wide woman who love him. 

Balance and Fibromyalgia

After 25 years of diagnosing and treating patients with fibromyalgia, I am struck by a perception of imbalance consistently present in the lives of patients with this syndrome. I too often observe individuals who are working too hard, not playing hard enough, and hardly resting at all. And more often than not, there seems to be a lack of time for stillness, reflection, and spiritual refreshment. It has long been my contention that reestablishing harmony among the different aspects of our selves—physical, intellectual, emotional and spiritual—would go a long way in restoring good-quality sleep, reducing pain and fatigue, and diminishing the central nervous system amplification associated with fibromyalgia.

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To Work in the Shade of a Wide Umbrella

Reader, welcome to this blog's first post. I hope you find the blog informative, insightful, interesting, (and other things that don't necessarily begin with the prefix "in"). We'll cover a lot of territory here. 

So, we begin with Pierre-Auguste Renoir, the famous 19th-century French impressionist who worked for over 60 years and created beauty (some claim he painted about 6000 pictures) all the while living with Rheumatoid Arthrtitis. 

Fortunately, 21st-century artists who live with RA have unbelievably more treatments available to them than Renoir; but it's not the thought of Rheumatoid Arthritis I want to leave with you. Rather, it's the thought of Renoir's "can-do" spirit that impresses me. We can hardly expect to live our lives without disease—and we have little control over that. Perhaps all we can control is how we structure healthy, productive days while living with the diseases that will accompany us. 

I encourage all of those living with disease,  and you, too, Reader, to seek fresh air, to work in the shade of a wide umbrella, to feel the comfort of a blanket draped across the shoulders, and to wear fashionable hats. And to do beautiful work.

Notice how Renoir holds his brush cupped between his twisted hands. Remain inventive.