What does your work involve?
I work in a team of rheumatologists, rheumatology nurse specialists, physiotherapists and an occupational therapist.
Working as a rheumatologist largely involves assessing and managing new and follow-up rheumatology patients referred from GPs. I manage a wide variety of conditions, predominantly in adult patients, including:
- different types of joint diseases
- problems with muscles, tendons and ligaments
- bone disorders including osteoporosis.
Most of my work is with inflammatory conditions like rheumatoid arthritis and most patients are managed as outpatients. Very ill patients may require admission for complex investigations and treatment.
Many patients require drugs to control their condition and will need close monitoring to make sure that they're responding and don't have side-effects. This generates many results from blood tests and x-rays and other investigations which all need to be carefully scrutinised to make sure that we are giving the best treatment safely.
What do you do on a typical working day?
Working days are long and full but varied and enjoyable. At least half the day will be in outpatients or on the day unit, assessing and treating patients. There are also patients on the wards who need to be looked after by all the team.
There's a great deal of office work which takes up a considerable amount of time. This includes:
- reviewing test results
- discussing complex results with specialists like radiologists
- dealing with correspondence.
It's very important to maintain close, regular communication with colleagues to make sure that patients receive the best possible care.
Why do you choose to do this work?
I am a third-generation doctor and second-generation rheumatologist. Rheumatology is often misunderstood as just dealing with old people with aches and pains. But it's a challenging discipline and with the greatly improved patient outcomes now achievable has become even more rewarding.
The stoicism and fortitude of many of the severely afflicted rheumatology patients is inspirational.
What is the best thing about this job?
The best thing is that I enjoy my job. The reason for this is two-fold. I work with great colleagues who I can share medical problems and a lot of fun and humour, which for me is a necessity. The second thing is the vast majority of patients.
What is the worst thing?
The worst thing is the over-demand, the lack of capacity to accommodate this demand and the financial constraints. Our clinics are constantly full and it is very difficult arranging to see patients as quickly as one would want.
How has research informed your work?
Research is such a fundamental requirement for improving management of patients and developing new therapies.
When I first started in rheumatology the number of drugs available was very limited and they didn’t work very well or they had significant side-effects. The exciting developments such as anti-TNF agents over the last 20 years have changed the face of rheumatology.
There's so much more hope now that the concept of achieving remission is very real for many of the conditions we see.
There are still large gaps in our understanding of many of the diseases we see and we lack medical treatments for some conditions like osteoarthritis. I hope that the ongoing research in rheumatology will find the answers and help even more of our patients to lead fulfilling and active lives without pain and suffering.
Dr Amanda Isdale is a consultant rheumatologist at York Hospital.