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Starchy White Coat and Dreams

I always wanted to be a doctor. I'm not quite sure what drove me to become a doctor, but there was something in my heart from the time I was a little rambunctious, smarty pants boy that inspired me towards medicine. I loved being around people, talking to them and becoming apart of their lives.

It was after only a few short years of my life that I realized my true calling. I remember my pediatrician that my mother used to take me to wore a clean, starchy, white coat. He had multiple pens in his left upper pocket and would always greet me like I was his child. He was always very interested and engaging asking about my young life. 

I remembered how people in the community loved him and I asked myself, what makes people so happy around him? One thing I knew was that I wanted to be like him, happy, energetic and most of all making people happy by helping them to heal. At around 9 years old, I decided I wanted to be a Doctor.

When I graduated from High School in 1995, I was ready to begin my journey to become a physician. I went to college, 4 years of undergraduate studies, 4 years of medical school, 3 years of residency in Internal Medicine and continued with another 2 years post graduate training to become a Rheumatologist. 

People often ask me why did you choose rheumatology? As a medical student, rheumatology was always associated with an air of mystery and complexity to me. Factors which might have aroused a younger man seeking a relationship with the opposite sex, the specialty didn’t catch my eye at all as an undergraduate. To a medical student cruising for medical action in the early 2000′s, rheumatology wouldn’t have got as far as a first date. Some medical specialties are cooler and sexier than others. Rheumatology could never really compete with the macho surgical greatness of heading down to theatre to sew a hand back on, performing open heart surgery or with the laid back anesthetic cool of medically paralyzing someone, stopping their heart and lungs and then starting them up all over again while reading the paper! Rheumatologists just didn’t wear leather jackets. They were just not cool...LOL.

At the time and despite best efforts my chosen specialty had an image problem. This wasn’t the fault of rheumatologists, we just didn’t yet have the effective tools at our disposal to significantly impact many of the diseases we treated. Nonetheless, this affected the attractiveness of our specialty to those choosing a career in hospital medicine and to our colleagues in other specialties.

Rheumatologists were seen by their colleagues as a specialist who provided a babysitting service, albeit with lots of steroids to the chronically unwell. Back in the early 1990's our clinics were full of struggling patients for whom the treatments didn’t work and there were even special clinics to deal with side effects to the drugs we were prescribing (gold clinics were not as glamorous as they sound).

With my heart set on a career in the rapidly evolving, hi-tech and terrifically sexy specialty of radiology, I decided to get some general medicine under my belt before going forward with interviews. A few months passed when I accidentally stumbled into rheumatology as part of one of my medical rotations in Arizona. I was extremely surprised that I really enjoyed the rotation. I remembered Dr. Hurowitz (my mentor), small old and frail looking, textbook smart, opera fan, newly widowed due to lung cancer, a geeky doctor who introduced me to this discipline. What a great mentor he was! If I were to be perfectly honest, the first thing I enjoyed about rheumatology was that it was a bit of a let down.

In my first few weeks that eary fall, I found myself regularly clipping my on-call beeper to the net of the hospital tennis courts so I could hit a few balls with another member of the team waiting for "something to happen".  Although it was a false dawn my unforseen career choice became much busier in the following weeks. I allowed myself to imagine a job which would permit for a life outside medicine. I was of course surrounded by other rheumatologists during my rotation. I found that I had a liking for the rheumatologists too. Most of them seemed to be very down to earth and had a genuine interest in the lives of the people they cared for. Rheumatology seemed to be a specialty where in most cases the patients  could wait to be seen until the morning. This allowed a measured committment to the workplace in those I worked with that seemed to also leave room for time with family, friends and for non-medical interests.

Although rheumatology is not as financially appealing as some other specialties, I resigned myself to the certainty that if I were to become a rheumatologist that I’d never own a Porsche, but then neither would I have to drive in the middle of the night to unblock someones coronary arteries. Rheumatologists also seem to have a level of familiarity with their patients. The type of physicians that one would imagine as an older rural family doctor, effortlessly blending the catch up familiarity of a chat between old friends with the medical business of dose adjustments, joint injections and referrals to orthopaedics. Whereas I now know that this approach and those relationships can take many years to develop, it feels great to attain meaningful relationships with your patients and thier families.

I enjoy the mix of clinical symptoms which present to the practice; in a single morning I may treat a patient with tennis elbow, rheumatoid arthritis, gout, osteoporosis, osteoarthritis, vasculitis, lupus and even a few chronically serious life threatening disease patients. There is a nice mix of clinical medicine where most of the diagnosis are attained from listening and examining, a bit of hi-tech imaging (with MRI, Nuclear Medicine) and a bit of nerdy hardcore science and immunology thrown in. Most of all though, I like my patients.

Rheumatology patients are an amazingly resilient, patient and an extremely forgiving group of people. They are often cheerfully resilient while coping with the ravages and disappointments of living with a chronic disease, some patients wait for slow acting treatments to work and at times practices run behind. They forgive thier rheumatologists when initial attempts to treat their disease fails (due to individual treatment plans, we have to sometimes chop and change until we get the right cocktail for each and every patient but they always express gratitude when things go well and their disease improves.

Thankfully rheumatology is entering a new era. The vast majority of patients with rheumatoid arthritis will do very well when in treatment. The impact that modern treatments have had on joint damage means that for most patients, joint deformities are rare and as result referrals to orthopedics and plastic surgery have dropped. Outcomes from sometimes fatal connective tissue disease like vasculitis and lupus have improved dramatically and we are now very good at treating gout, osteoporosis and have seen improvement with chronic pain management.

Although I always thought that rheumatologists had good reason to feel positive about their role in the lives of their patients and their place in medicine, I think it is about time we added a little swagger to our ward rounds. Thanks to my early years, to my parents, to my pediatrician that glowed my true calling, to my 13 years of school, to my practice manager, staff and to all my patients during the past 6 years in Central Florida and of of course to that old, frailed, textbook smart, opera fan, geeky Dr. Hurowitz that paved my way, I am proud to be a Rheumatologist.

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