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RHEUMATOLOGIST SHOULD BE ACCEPTEDAS A MEDICAL ORTHOPAEDIC SPECIALIST
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
The layman always goes to an orthopaedic surgeon for any complaint related to the bones and joints. So orthopaedic surgeons have been privileged to treat everything connected with bones and joints. Unfortunately, because of their heavy load of surgical work, they have not been able to cope up with the medical and diagnostic part.
About 20 years ago, Rheumatology came as a new medical speciality. Since then, I have been seeing the approach of the rheumatologists, in case the patient happens to reach their clinic.
In my opinion, all such patients (including backache, where MRI shows a prolapsed disc) should be seen by a rheumatologist. Only if he advises a surgical interference, should the patient be passed on to an orthopaedic surgeon by the GP. I have seen many such patients where a micro-discectomy is done or else, old fashioned treatment of bed rest and traction is given by an orthopaedic surgeon.
What is happening on the cardiological and nephrology side should be followed here as well. The heart patient is first sent to a cardiologist and only when he decides, is the patient referred to an interventional specialist or a cardiac surgeon.
Similarly, a nephrologist will be a better person to decide whether the kidney patient needs any surgical interference.
A good rheumatologist who is conversant with day to day research work and statistics, will not give any attention to the MRI findings, but treat backache as `backache' without any bed rest or surgical interference.
Recently, I saw a young lady, having pain in the right arm, diagnosed as frozen shoulder and given a sling to immobilise her right arm. After 48 hours, when she saw me, she had all the signs of `Reflex sympathetic dystrophy syndrome' where mobilisation is the most important part of the treatment. Her hand was more or less paralysed because of the wrong advice!!
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