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

100 thoughts on “Day in the Life of a DOCTOR: INJECTIONS! (Rheumatology)

  1. I wish I knew that you are in London, I would come to say hi, I go to the same floor too, but to a different doctor. As a patient, not a doctor lol.

  2. Sorry for the ramble, but in healthcare there are some conditions that can fall through the cracks as no one wants to take ownership – I don’t how you find that, but in the UK it happens. I have Ehlers-Danlos Syndrome pretty severely. I was diagnosed by a specialist but there are only two EDS clinics in the whole of the UK with huge demand on them, they tend to diagnosis and discharge back to local hospital care.

    Except for many there is none. I’ve seen many rheumatologist in my life and they lose interest when it’s not rheumatoid-arthritis. The connective tissue specialist rheumatologist at my local hospital wrote to my GP saying that he had ‘no interest in managing Ehlers-Danlos Syndrome’. So I now muddle along by myself, unable to walk and in horrendous pain just trying to manage my own symptoms. I say thank goodness for google as I’m treating myself so that helps guide me what’s bad and what isn’t!

  3. My mom worked in the lab at this hospital! She was a micro biologist! This is so so cool. I knew I recognized the hospital! I also went there when I went on vacation the same day I got pneumonia. I will have to send this video to my mom, she worked there around when she was my age, 22.

  4. I actually have Rheumatoid Arthritis! I've also had one of these injections and wish I could have had you instead of the doctor I had!!! You're so sweet and kind and are such a good doctor! Your patients are lucky to have you as a doctor!

  5. Rehumatology patients look up Mikhaila Peterson's blog "Dont Eat That" to read her amazing story of how she's on remission from her rehumatoid arthritis thanks to the carnivore diet!

  6. When you become a Resident do you get to choose which specialty you want to work in? Or do you have to get training in all specialties? I think you would be an AMAZING Obsetrician or Pediatrician. You have the best bedside manners I have ever seen in the Medical field. You are very calm, reassuring, always smiling and happy even if you have pulled over an 24 hour shift. Which specialty works the most hours in a hospital? I'm going to guess an Obstetrician or Emergency Medicine.

  7. 🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔😜😜🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔😊🤔🤔🤔😜😜😜😜😜🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔🤔

  8. Oh I've got to comment! You are so so so lovely, and it's so interesting watching these videos. My friend has recently gone into the medical field, so I kinda get an inside look into her job through you! Hahah. Also Lupus is rare as hey, My rheumatologist that sees me (for lupus) currently only has one other patient with it. We both just had unprovoked PE's as well! Totally twinning.
    Anyway, you got yourself another subscriber, happy to be along for the journey. 🙂

  9. As a person who has recently been diagnosed with lupus (Yes, Dr. House, it sometimes is lupus 😉) I found this behind-the-scenes look into rheumatology interesting!

  10. This is awesome! I’ve had JRA since I was 8 and a year later i became incredibly ill and they couldn’t figure out what was wrong with me. After weeks of being in the hospital and having kidney failure they diagnosed me with Lupus (my moms suggestion to test me for it). I was 9 years old at the time and my lupus was really out of control.

  11. my sister has that but all the doctors cant do nothing and she has like that hippy pen i think it is what can she do to fix it bc we live in California

  12. My friend John is 19, and has an issue with his feet and hands. So he is a heavy drinker, drinks every night after college and work, and is typically hungover coming into college. His hands go red, ice cold and swell, and he has pains from his feet he blames on work as he is on his feet daily. But sometimes when he isn't working his feet still are incredibly painful, he won't go to the doctors and I'm worried he may have ever an extremely over active thyroid or rheumatoid arthritis.

    His hands remain red, swollen and cold to touch for hours. Sometimes the entire day.

  13. I have a question my mom has RA arthritis and her feet and hands are deformed is there anything we can do for her. She also has lost all muscle tone is there away for here again muscle tone. Also how much of a chance does me or my daughter have to get RA Arthritis. My aunts also have it

  14. Hi! I am new and about to go to med school in America! I am curious to see what u wear during the day time? Most of the time, doctors wear scrubs in the ER! Love ur videos

  15. the Tumhare video bahut acchi lagti hai bahut acchi I love you tumhare video lekin Hindi mai bolo mujhe English nahi aati Mera video Jarur dekhna

  16. DO you do skin testing before you inject medications? I have allergies to Lidocaine, Novocaine, Posicaine and the likes. What do you do then? Thank you

  17. I don't like this channel, i think is a doctor… Stupid doctor,…. That not is well. Someone should stop to this""doctor" ".

  18. I have a concussion and I found out how to use my phone with out looking at my screen so I am just listening and it is way more fun than just laying in the dark doing nothing

  19. I love Dr. House because he is absolutely brilliant and does everything in his power to help his patients get well without sugarcoating everything (I hate it when doctors do that). As for his poor bedside manner, I think he gets frustrated because his average IQ colleagues don't understand half of what he does, so, they come running to him for everything, even when he's in the doghouse, so to speak.

  20. This is honestly probably one of my favorite videos I’ve watched. I have psoriatic arthritis and I was diagnosed at the age of 11-12. I can honestly say that you get used to living with it and some days are worse than others and not all medications work, you have to go through so many before you find what works. I actually went into remission for a year and then it flared up all over again, and I dont remember what it’s like to not be in pain. But I have gained a high pain tolerance from it so I am able to do a lot of things others can’t that have arthritis like I do. Thank you for the video ☺️

  21. I have psoriatic arthritis, i was diagnosed with juvenile idiopathic arthritis at 16, but later found out it was psoriatic arthritis. The psoriasis came later and I’ve never actually had major issues with it, the big issue has just always been the arthritis. It made me want to go into the medical field and I want to be a PA or nurse practitioner for Rheumotology now because I had no idea it was a thing until I was diagnosed and found an interest in it. So thanks for this video 😊😊 I’m glad you’re making people more aware of it 😊

  22. I've had juvenile arthritis since the age of 14 and now diagnosed as psoriatic arthritis. it's nice to follow a day in "my" doctors work life 🙂

  23. Hi 👋🏻🤘🏻🤘🏻🤘🏻🤘🏻🤘🏻🤘🏻🤘🏻🤘🏻🤘🏻🤘🏻🤘🏻🤘🏻🤘🏻🇺🇸😘❤️

  24. I have diagnosed rheumatoid arthritis which especially flares up when it gets cold out. Even if I'm indoors, my body knows and my joints become stiff. For a few years now, I discovered golden milk (turmeric milk) which actually helps with inflammation. As long as I keep on top of it (just like taking meds), my symptoms don't flare up.

  25. Did you really recap the needle after lying it on the table for a chronically immunocompromised patient?

  26. We can do a lot of things, like inject meds or have you pop them daily instead. Change your diets people and you won’t need to be giving these people any money or time!!

  27. I have had fluid drained from my knee before and it was incredibly painful…..just looking at that giant needle is giving me flashbacks….

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