Day in the Life of a DOCTOR: INJECTIONS! (Rheumatology)

Day in the Life of a DOCTOR: INJECTIONS! (Rheumatology)


Morning guys, I’m Siobhan a second-year medical resident. Oh my gosh, it is so snowy and slippery Holy moly Right now, I’m actually on a visiting elective which means I go to a different city, a different Hospital and I get to experience Different medical cultures. So right now I’m doing rheumatology and I am heading to clinic. I’ve rented a car. I’m living a new place So it’s a bit of an adjustment and an adventure. So, let’s see what today brings Today I’m working with Dr. Pope She’s an internationally renowned rheumatologist and she’s an incredible advocate for her patients So let’s go and meet her and you guys can find out a little bit more about what rheumatologists do Hi, I’m Dr. Janet Pope. I’m a Rheumatologist here at St. Joe’s health care in London, Ontario, and I’m a professor of medicine Here’s what a Rheumatologist does We see patients with inflammatory arthritis. We also see things like Osteoarthritis and tendonitis we can inject joints, but we also are general internist So we look and see what’s going on of autoimmune inflammation and treating that with various medications So we do a lot of different things. (Siobhan) So if you could talk to Dr House MD who always says it’s not lupus. It’s not lupus. What would you say to him? So for Dr House, I’d say first of all you’re really crusty and you have to have better bedside manner. So you’re funny, but you’re very cynical Rheumatology sees a lot of things but lupus is still kind of rare one in a thousand so we have Hundreds of patients with lupus because of large practices, but it’s not lupus But I’d still tell him I think he needs a better bedside manner and he should do some Rheumatology training and maybe even better (Siobhan) The first patient I’m seeing is a follow-up appointment for rheumatoid arthritis (Siobhan) So I start out by reading all their previous clinic notes and reviewing the most recent lab work (Siobhan) Then I head in and see the patient and hear how they’ve been doing recently (Siobhan) I do a physical exam and then I go and find Dr (Siobhan) Pope and I present her with a summary of all my findings and put forward a plan that I think is most (Siobhan) Appropriate for this patient. So this is the moment of truth. Does Dr (Siobhan) Pope agree with what I think, and if she doesn’t, honestly it’s just a learning opportunity and I get to learn from her expertise (Siobhan) Finally we go in and see the patient together make a plan and then send the patient on their way (Siobhan) The next patients coming in for an urgent appointment for a flare of their psoriatic arthritis and the thing that’s bothering them the most is a really swollen knee. So Our plan is to do an injection. So we’re gonna be Injecting some steroid into the knee to help decrease the inflammation So that then they can do some physio and sort of get back to their normal schedule while we’re adjusting their main medications (Siobhan) So I’m mixing in freezing agent called lidocaine with the steroid (Siobhan) This allows the patient to get some immediate relief (Siobhan) Because the steroid actually takes a bit of time to kick in before it starts decreasing the inflammation (Siobhan) Or at least until the patient starts feeling it Okay, so you’ve got a moment where there are no patients waiting to be seen so I’ve got three to dictate three patient’s that I’ve Seen and having dictated yet So I’m gonna take this moment to at least dictate one or two So I don’t have too big of a pile at the end of the day Please enter your user ID followed by the pound sign If you like we started to hear the same things I went over so many times Please into your site code followed by the pound key, please into your work type now this part get’s confidential so Okay one dictation done I’m going to double check and see if there any patients waiting before I Get starting a second one and I’ll just start a pile of dictations to do (Siobhan) The next patient is a consult. It’s a young woman with arthritis N.Y.D. (Siobhan) Meaning: Not Yet Diagnosed. They’re still not yet diagnosed, but we’re getting closer to it so they’ve had this persistent swelling in their hands and it sounds a lot like Rheumatoid arthritis because it’s in both hands feet are a bit painful But it’s so early on and it’s hard to tell so unfortunately the patient’s not walking away with a diagnosis But we’re gonna get closer by doing x-rays and doing some blood work Ruling out some infections and making sure it’s not any other type of condition Anyway, I love this part the thing that sucks though. Is that like by the time this patient comes back into clinic? I’ll, I’ll be back on a different rotation and I won’t actually get to follow up on this So one day when I actually get to follow up with patients long term, that’ll that’ll be really satisfying So it’s a super diverse clinic day. I just finished seeing a patient with psoriatic arthritis So they have psoriasis the type of skin condition But then on top of that they end up getting arthritis that’s related to the psoriasis So there are a ton of different types of arthritis. It’s not as easy as just like what your grandmother has So that’s our job. It’s working out what’s causing it and then we can treat it okay, so the Rheumatology fellows so the ones who are specializing in rheumatology after internal medicine have agreed to Answer some questions and tell you guys what it’s like in rheumatology (Siobhan)Yeah, do you guys know what these things are actually used for? (Fellow) X-Rays (Siobhan) Yeah, these were X-Ray machines before, and now they’re just use for a critical message (Siobhan) Can I please include that? Oh, God (Siobhan) What do you think people are most scared of when I come in like what diagnosis do you think most people are scared that they have? Lupus. It’s not lupus. Yeah Because there are Scary images on the internet and Google is great, but it’s also found terrifying because you Google lupus and you see always the worst things that can happen and people might give them the Diagnosis of lupus and they immediately ask you, “Am I gonna look like that?”, and you have to calmly Tell them that, “No we have good medications to make sure you don’t have those symptoms and if, even if you do We can control things” (Siobhan) If you were diagnosed with an autoimmune disease (Siobhan) Would you google it? Yeah Think it’s a cruel double-edged sword Everyone wants to know but you kind of know that the is full of terrifying versions.
My answer would be yes You just have to find the right sources so you have to be careful in doing so and kind of try to gather whether what you’re looking at is something that’s in the medical world would somewhat agree with Okay, so clinic finished way earlier that I was expecting Actually, we were efficient and I just finished dictating my pile of charts. And now the other part of Rheumatology is Consults and seeing patients in the hospital. So I’m gonna try to find May. I think she’s one of the fellows on call Good you’re on call right? I am. Okay. So what’s the situation? I’m just gonna dictate these charts for tonight. And today we haven’t had any consults. So you and I are probably off for tonight Okay, that is so different than internal medicine call when you go to see me 26 hours in the hospital there’s something called home call and that’s Rheumatology call so you get called in when you need to go But otherwise you don’t have to just sleep in a hospital for no reason All right guys done for the day. I want to give a huge. Thank you to Dr Pope and to the amazing fellows who contributed to this video. It was so much fun to have them here I never want to go to the gym after a day of clinics, so I have left my stuff in the car There’s no excuse. I have to go and do it. So you guys are my witness. I’m gonna go there now Anyway, don’t forget to subscribe if you want to see a lots more videos like this And otherwise, I’ll be chatting with you guys next weeks. So bye for now

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