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Can't Wait 'til It's Over

Five weeks from now, April 11, I will travel to Kings Island in Mason, Ohio to take my 2nd rheumatology recertification exam---rheumatologists must recertify every ten years.

Prior to taking the exam, physicians complete multiple open-book tests and complete a tedious exercise referred to as a "practice improvement module."  So I have been spending the past several months studying at home every evening. All of this is quite labor intensive but, I must admit, it's helpful. Read more »

Spirituality and Disease

I read the most intriguing chapter this morning from a book written by Emmet Fox in 1932, that ultimately inspired the formation of 12 Step programs, such as Alcoholics Anonymous. Read more »

Cincinnati Rheumatologist Eagerly Anticipates New Year

I look forward to seeing my patients in 2012, as I have come to place extreme value on the relationships that I have established with patients over the past 25 years. I look forward to facing the challenges of meeting electronic health record requirements because it keeps me and my staff on our toes and not bored with old systems. And I look forward to learning more and more rheumatology as medical research progresses and offers hope to those who suffer with arthritis, autoimmune and inflammatory diseases. Read more »

Arthrits and Golf in Cincinnati

Playing golf well is not easy. Neither is living with arthritis. I know firsthand about the challenges of golf— I want to shoot under 80, but I don't...yet.

I know a little bit about arthritis from a personal perspective (I have some osteoarthritis in my back), but mostly I know how difficult it is to live with arthritis from the experiences my patients share with me. Each day people who live with rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and gout must determine to get up, exercise, work, play, have relationships, and enjoy life. And just as the game of golf has its ups and downs, its moments of success and times of disappointment, life with arthritis can certainly be unpredictable.

But we push on, we keep trying new approaches and working hard. Because it's worth it. Golf is only a game, whereas living with arthritis is serious business. But both can be fun, full, and rewarding, if we keep trying. Or, we can give in, settle for bogeys rather than pars, focus on our disease rather than our health, and miss the joy of the journey.

I Took my Diabetes on a Bicycle Ride

Yesterday I rode my bicycle, and I planned my ride so it included a visit to the polls (it was election day). I didn't want to ride my bicycle, and I didn't want to vote. For some reason, yesterday I just didn't care, and I didn't want to do two things I know are good for me. I could have put the bike ride off, but I couldn't comfortably live with myself if I didn't vote, so I decided to kill two birds I didn't want with one stone: a bicycle ride to the polls. 

As usual, I felt much better after a couple of pedal strokes, and I felt awesome voting in my bicycle helmet and gloves. I turned heads. I like to turn heads. And, let me tell you, I voted as you might expect a person who rides a bicycle in this community to vote...I voted differently than my neighbors. But that's not my point.

I took a different route home, and I spotted one of my neighbors out raking his leaves. Most of our neighbors have lawn services, so he goes a little against the grain, too. Lately he's been alluding to the fact that his health isn't so good, so I stopped to learn from him what's going on. He lives alone and has no family in town, and if his health is failing, he'll need some support.

I learned that the kidney disease my neighbor has lived with for many years is rapidly shifting; he'll probably soon begin dialysis and go on a transplant waiting list. (I asked him what he needed. He said, "A donor." Uh oh. I'll save the conversation that occured between my higher and lower natures upon hearing that response for another post.)

Here's my point today: I have Type 1 Diabetes. My neighbor has kidney disease. Neither of us knew of the others' disease even though we've lived with these companions for a long time. I was riding my bicycle. He was raking his leaves. We were not sitting inside watching TV and complaining. We talked a little bit about being healthy people who happen to have diseases. Then we got all worked up talking about politics (we lean the same way). 

Yes, disease may take us. It may change what we do and how we do it. So there you go. Disease does not get to make us unhealthy or unhappy. 

Cincinnati Rheumatologist Blogs from 2011 ACR: What Is Education?

Evelyn V. Hess, MDEvelyn V. Hess, MDWhen I completed my rheumatology fellowship at the University of Cincinnati, I told my mentor, Dr. Evelyn Hess, that I was elated and relieved to have finally completed my medical education; now I could rest.

Dr. Hess quickly shot back (with an expression similar to the expression she wears in the image I've posted of her here) that I had only just begun my educational process and that I would be studying and learning for the rest of my life. I looked at her strangely, though I somehow knew she was right. The next day, I began my vacation in Hawaii. 

After one month of rest, I hung out my shingle...I opened my private practice...and yes, my true education really began then. Not only did I have to start independently putting into practice the knowledge I had acquired over the years, as I was now seeing patients completely without supervision for the first time (an intimidating realization for any new doctor), but I was also learning the nuances of running a business and earning a living.

Twenty four years later, I continue to see patients and manage a private practice. The field of rheumatology has grown exponentially since I completed my formal education. But by staying connected to research and excellent rheumatologists at UC (where I have worked in the outpatient clinic since my fellowship), by reading journals, and by attending annual ACR meetings, I have expanded my knowledge base in synchrony with the growth in my field. All this education is actually delightful—it's as if each new thought and new discovery adds granules of sand atop an ever-expanding base...I picture it in my mind's eye as a giant sand pyramid. At this point in my career and in my education, because I've constructed a solid, wide base of knowledge in which to anchor new information, I can sit back at meetings and absorb the gestalt of a lecture rather than fervishly writing notes and facts as many of us do when we're learning something new. 

The greater challenge to me these days is keeping abreast of the swiftly changing administrative aspect of running a medical practice—electronic health records, revised coding and documentation requirements, etc, are radically changing how physicians practice medicine and earn a living. Once again, a part of my education is only beginning. It keeps me sharp. I didn't realize, back then, how right Dr. Hess really was. 

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.

Read more »

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. 

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