Put Your Rheumatology Specs Away with New Patients

Remember those “x-ray specs” they used to sell in the back of comic books? You’d send in your entire allowance, and in just 6-8 weeks, your x-ray specs would arrive in the mail, instantly allowing you to be able to see through walls, clothing, you name it.

Oh, you say you’re too young to remember those? Well, humor me. Pretend you remember them. And just know that you totally missed out on some of the best ads in the history of advertising if you weren’t a comic book fan in the 80s. These back-page ads weren’t just for x-ray specs. They sold fake vomit! And chattering teeth! And whoopie cushions! It was a veritable plethora of stupid fun.

Unfortunately, the x-ray specs were, of course, fake. The point is that sometimes I feel like I’ve been walking around with “x-ray specs” on for a long time, only mine are called “Rheumatology Specs,” and they make it seem perfectly natural to talk to co-workers about things like chronic disease, immunology, inflammation, and comorbidities. We hold entire conversations using strange acronyms, and because we are all wearing our Rheumatology Specs, this crazy stuff seems quite normal to us.

What we always need to remember, however, is that our patients never filled out that back-page order form, so they don’t have those Rheumatology Specs, especially when they are newly diagnosed. Most of them didn’t even know they had things called “synovia,” and now they find out they not only have them, but they are inflamed and We.Must.Do.Something.About.That.Right.Away. Or worse, that weird “rosacea” they have had for years is actually lupus, and lots of people are suddenly talking to them in earnest about blood tests and kidney function and spinning urine when really all they wanted was for someone to give them a cream to make the rash go away. Now, here they are being told that, from now on, pregnancy might be “difficult.” It’s a wonder our patients ever come back for a second visit!

So what’s the answer? Do we give every patient a pair of magical Rheumatology Specs along with detailed explanations of everything they probably never wanted to know? Do we try to get them to see the world the way we see it? I would argue that the answer to both of these questions is “no.”

“We need to take off our Rheumatology Specs and just be human beings. It’s up to us to sit down, look our patients in the eye, and ask, ‘How can I help you today?'”

As anxious as we are to make our new patients understand the ins and outs of their chronic disease, I think the most important gift we can give our patients on their first (and possibly second, third, and even fourth) visit after their diagnosis has been made is silence. We need to take off our Rheumatology Specs and just be human beings. It’s up to us to sit down, look our patients in the eye, and ask, “How can I help you today?”

Most patients will answer this question by asking about the issues that are most important to them. It’s critical to remember that what is important to us, as caregivers, isn’t worth a hill of beans compared to what’s important to our patients. So when a patient who is newly diagnosed with rheumatoid arthritis wants to know if there is a vitamin he can take to make his body “fight off” the disease, guess what our conversation should be about? That’s right—vitamins. Maybe at the end of the conversation we can slip in a plug for adherence to disease-modifying anti-rheumatic drugs, but only if the patient is ready to listen.

The first few visits with a new patient are so important for team-building and establishing trust. It can be helpful to start out by telling newly-diagnosed patients that they have just started a marathon and finding the answers to their pain and other issues will not happen next week or next month. There will be plenty of time for us to ask our patients questions. Once the pressure is off and their minds are somewhat clearer, we can put our Rheumatology Specs on—just for a few minutes at a time!—and get to work.

Elizabeth Kirchner, CNP, RN-BC, is a nurse practictioner at the Cleveland Clinic in Cleveland, Ohio, and the Education and Curriculum Chair of the Rheumatology Nurses Society.