Evo Terra (host):
Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Evo Terra and I'm joined today by Dr. Richard Brian, a rheumatologist at the medical Group at Montefiore St. Luke's, Cornwall. To find out more about rheumatology, Dr. Brian. Welcome.
Richard Bryan, MD:
Oh, thank you for having me, Evo. It's a pleasure to be here.
Host:
Well, like a lot of people, I thought that rheumatism was something that afflicted people a hundred years ago, but clearly that's not true, 'cause you and I are having a conversation about this today. So tell me, what do rheumatologists like yourself treat?
Richard Bryan, MD:
Okay, well, let's try and demystify, right, because, uh—and it's very simplified definition. A rheumatologist is essentially a joint doctor, right? We deal with the joint pains that many patient's will complain of. But that's a very simplified view because joint pain really represents the tip of the iceberg when you come to think of it, right? What's going on in the joints is really indicative of what's going on from head to toe. So joint pain on many occasions is also connected to inflammation in the liver, inflammation in the heart, inflammation in the lungs, the kidneys, and other organ systems that the patient perhaps might not be aware of. So they will get up, they have difficulties rising out of bed because of the joint pain and stiffness, and that's what gets them in to see me. But there is so much more going on. So I like to think of it and describe it as the joints being indicative of the whole. So addressing the joint pain means that one therefore needs to also address the multiple other organ systems that are also being affected. So to circle back to your question. Evil, which is what is a rheumatologist and what does a rheumatologist do? Well, the way I like to describe it is as a rheumatologist addresses joint pain and the multiple complications that can arise from joint pain, and in doing so, attempt to get that patient back to the quality of life that is expected.
Host:
That's quite interesting. I had not put the connection together between a joint pain—my knee hurts, my first index finger has a little arthritis in it. Where's that coming from? And I hadn't considered the fact that it could be any place other than the joint itself that's causing it. Maybe you could help me with that. What are some of the more common rheumatological conditions that you treat?
Richard Bryan, MD:
So I try to think of it, whenever someone asks, "Tell me a bit more about joint pain, Dr. Brian," I'll say, "Well, there's a simple dichotomy: just think of joint pain that's driven by inflammation and joint pain that isn't." Now, the joint pain that isn't driven by inflammation is localized. So if someone has non-inflammatory left knee pain, well, that's just knee pain that is localized to the knee. It's not associated with anything else. So that's non-inflammatory: it's not driven by a systemic process, and that's the reason why perhaps an orthopedist will perform injections to that joint, or heavens forbid, it gets so severe to the point where that joint needs to be replaced. That's addressing a localized reason for joint pain, and that's non-inflammatory. But the other half of that coin, right? The other side of that coin is joint pain that is due to a systemic inflammatory process—systemic meaning system-wide from head to toe. So that knee pain is indicative of inflammation in the eyes, heart, lungs, liver, kidney, skin. So it's not uncommon then for one to have other complaints beyond just that left knee pain, like dry eyes or sores in the mouth or fingertips and toes changing color in the cold, or sores on the fingertips, or a rash or inflamed eyes. So it's imperative on the rheumatologist to get a very comprehensive, a holistic history, a very comprehensive history to see if there are any other organ systems in which there is a manifestation of inflammation, because that could lead us down a path that suggests that this knee pain is secondary to a systemic inflammatory condition that needs to be addressed.
Host:
And I'm assuming, and please correct me if I'm wrong, that most patients that have pain from inflammation don't really know that it's from inflammation of something. They just have pain and they need some help figuring out what that pain's coming from. Is that a true statement?
Richard Bryan, MD:
That's correct. And that's why, when they're seen by someone such as myself, we can dissect that, we can unpack it, and we can say, "Okay, this is where we need to think a little deeper," or not. But bear in mind as well, Evo, that there are also other hallmarks of inflammation, right? If someone has, let's say, knee pain, there is also warmth, swelling, redness. These are hallmarks of inflammation. So the patient will come in and they will say, "You know what? I have this subjective feeling of inflammation, but I'm also looking at it, and it certainly looks inflamed." So, yes.
Host:
Got it. That helps. So I want to talk about a couple of things before we finish here. The first one is let's talk about treatment. If my liver is inflamed and that's what's causing my right shoulder to hurt—by the way, doc, my right shoulder hurts—and we'll talk about that later. What do you do? How do you treat that?
Richard Bryan, MD:
Okay, so just to dovetail on one of the questions that you had asked earlier that I don't think I answered clearly, well, conditions that can cause these systemic findings include things like rheumatoid arthritis, lupus, and the ten lupus-like conditions; psoriasis causing psoriatic arthritis—psoriasis is a skin condition, but that skin condition can be associated with joint pain as well; ulcerative colitis or Crohn's colitis—these are inflammatory bowel conditions that can cause joint pain as well; many infections can cause systemic inflammatory joint pain like Lyme disease—everyone thinks of Lyme, but the usual culprits are like a belly bug or an upper respiratory tract infection. So these are all the conditions that can cause systemic inflammatory rheumatologic conditions. Now, to go back to the question that you just asked, which is how does one treat these conditions? Well, the underlying process is uncontrolled inflammation. So essentially potent anti-inflammatories are what are needed. Anti-inflammatories can come in a series of different potencies. We have the very weak, like Motrin, Aleve, right? These are nonsteroidal anti-inflammatory medications. We have intermediate strength disease-modifying antirheumatic drugs like methotrexate and hydroxychloroquine, Plaquenil and azathioprine and so on. And also in that intermediate-strength category, we're talking about steroids—the ubiquitous prednisone—that is much maligned simply because it has been used indiscriminately, and as a result, we see a lot of the potential complications of chronic use. But now, with the advent of the two thousands, Evo, we have revolutionized the game of rheumatology because now we have medications that are very strong anti-inflammatories, meaning they wipe out inflammation, achieving remission—not cure, but remission—and halting any additional damage from any lingering inflammation that could be going on. And these are the biologic agents that perhaps you'll see on the television. And by that I mean like Humira and Enbrel and Remicade and Cosentyx and Taltz and so on. So these are all biologic agents, biologics, simply because they are proteins that have to be refrigerated and have to be injected or infused directly into the veins in order to be active. So these are proteins, but we have taken it one step further. We now have medications that are of similar potency but are now inorganic. They're now oral options, and you'll see medications like Rinvoq or Xeljanz—maybe you've seen these on the television as well. These are medications that are of similar potency, meaning the very strong anti-inflammatories that are capable of putting someone in remission, but now, instead of needing to be refrigerated or needing to be infused or injected, now the patient can just take one tablet every day, and it works wonderfully as well. So these advances have changed the scope of rheumatology, and this is the golden age for rheumatology because these autoimmune conditions, which are essentially what the inflammatory conditions are, can now be placed in remission.
Richard Bryan, MD:
Remission, meaning a complete C of smoldering damage, so it for.
Host:
Yeah, it sounds exciting. I know people who've had lupus—I've known them for years, and in my childhood, I knew people who had lupus, is what I'm trying to say. There wasn't a lot of options for them. Now, what you were saying sounds like if you have your information about treating inflammatory rheumatoid conditions and your information is from the nineties, that's a whole new world out there.
Richard Bryan, MD:
Precisely. It's a whole new world and, in the eighties, nineties, we were content with just having someone feeling good enough to be able to perform their basic activities of daily living. "That's good enough." We're happy you can do the things you want to do with a little pain. Now, that is unacceptable because now we have the tools, we have the medications, we have the know-how to get someone to being in remission, to do the somersaults that they've always wanted to do, to go golfing and play eighteen holes and not have to limp the entire way. Anything less than that is deemed a failure. That's unacceptable with the tools that we now have at our disposal.
Host:
How does one determine if they need to see a rheumatologist? Because in my head you already know, but at some point in time you have to be diagnosed, I guess. So how does someone know?
Richard Bryan, MD:
So what generally will bring someone in to see me is joint pain. So someone—they generally jump out of bed and they can't do their activities, and then they realize that they're having increasing difficulties doing that. Well, that's a reason for them to say, "You know what? What's going on? Is this a joint issue? Is it localized to the joint only, or is there something else going on that's reason enough for them to come and see me?" But there are other reasons as well, right? If someone has a red eye, they see their ophthalmologist and the ophthalmologist said, "You know what, this is uveitis." The ophthalmologist has that heightened index of suspicion and says, "Uveitis in this person is oftentimes associated with a systemic rheumatologic condition. I'm going to send them to rheumatology." So this underscores a very important point, Evo. And that point is that community providers need to be educated and have a heightened index of suspicion for realizing when patients need to be sent to the rheumatologist. And this has been my goal, and this has been my objective, and I'm very steadfast in getting out to the community physicians and the community providers and having them be aware of when and how and why they need to send these patients over to the rheumatologist sooner rather than later. The patients, generally any kind of joint pain, will come to the rheumatologist and then we can start the workup from there.
Host:
And as you're talking, I realize I would imagine a lot of people who are being treated for these conditions might be treated by their primary care physician or others that are doing it, without getting a rheumatologist involved. How does a patient that suspects they might need to see a rheumatologist have that conversation with their community provider to let them say, "Hey, can I get a second opinion?" Is that what they're asking?
Richard Bryan, MD:
Mm-hmm. What we have going for us is that our primary care physicians and our primary care providers are very well learned and trained, and they're very good—and in this region, they are excellent. So whenever a patient comes in with complaints like those, our primary care providers will immediately think of a rheumatology consultation to help demystify some of these complaints. So all that patient needs to do is mention that to the primary care provider, and they will be referred over, and we are very accommodating as well as rheumatologists in this community. My prime directive is to be available to my community. My prime directive is to be all that I can to the patients in this community. So whenever a provider calls me up—and many of them have my cell number—they can get in touch with me at any time. Whenever they call me up or message me and say, "Listen, Dr. Brian, I have concerns about this patient. I'd like for them to come over and see you, second opinion, or just to hear your thoughts." I accept them gladly. So having that communication and being so available has made the process so much easier for us and our patients.
Host:
That is wonderful to hear. So what does a first-time visit with you look like for the patient?
Richard Bryan, MD:
A first-time visit is what we would describe as a consultation and soup to nuts. We're going through everything. I take a very comprehensive approach. I'm going to ask—I need to understand everything about the onset of the complaints. So if someone has knee pain, well, when did it start? Any trauma history? Has this happened before? I need to know all of these things. Is there any swelling associated with it? Is it worse in the evening or in the mornings? Has it ever given out? So I need to delve deep into the nature of that knee pain and of that complaint. That visit will be centered around getting all of that information, but not just that. Many of these rheumatologic conditions also have a strong genetic component, so I have to delve into the family history as well. I have to also delve into occupational history, occupational exposure. And then, after I gather all of that information, I have to do a thorough physical exam. I need to look at everything from head to toe, because as I mentioned earlier, many of these conditions don't just affect the joints. So the person may have come in to see me with left knee pain, but when I check behind the left ear, I see a dry, scaly rash. And that person tells me that, "Oh yeah, by the way, that rash has been there for the past fifteen years. It's very itchy, it gets scaly, sometimes it flakes off. I put on a topical steroid, it gets better, but then it comes back. It's never really bothered me, so I never really thought much about it." Well, the thing is, Evo, that rash could be tied into the knee pain, because that rash could, in fact, be psoriasis. And we know that forty percent of patients with psoriasis can have psoriatic arthritis, and psoriatic arthritis also loves the knees. So now I'm putting it together, so I get a thorough history, a thorough physical, and now I'm trying to unify the complaints, right? Because you don't want to have ten different complaints with ten different diagnoses. Oftentimes you can have ten different complaints that can be unified by two different diagnoses if you are thinking in the manner in which one should.
Host:
This is an amazing bit of information, 'cause I think people don't quite understand how much things have advanced in the process. Before I let you go, anything else you would like to add?
Richard Bryan, MD:
So, Evo, it's education. I spend a lot of time educating my patients, because I find that an educated patient—a patient who knows one, what their diagnosis is; two, what the plan is; three, what the expectations are; and the fact that they will be recruited in their healthcare—that makes my job so much easier. And I spend a lot of time educating my patients about what it is that I'm doing and what their condition is, because they have to be their strongest advocate. And the more they know, the better they can advocate. Now, in this day and age of social media and information at our fingertips, it's not uncommon for me to have patients coming in and they've done all this reading and they've done all this stuff, and they have a wealth of information. Well, I generally welcome that, because my job is to distill that information and for that information to make sense to them. They've already taken the initiative to get that information. Now I try to distill it, and they leave feeling edified.
Host:
Dr. Ryan, thank you very much for all the information today.
Richard Bryan, MD:
No, no, the pleasure is all mine, and I'm so glad that you could take the time to chat with me today. Thank you.
Host:
You're welcome. Thanks once again to Dr. Brian for all of this fantastic information and good news today, and thanks to you for listening to Doc Talk presented by Montefiore St. Luke's Cornwall. To learn more about rheumatology services as well as other specialty and primary care services, please visit slc med group.com. I have been your host, Evo Terra. Please remember to subscribe, rate, and review this podcast and all the other Montefiore St. Luke's Cornwall podcasts. Thanks for listening.
Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Evo Terra and I'm joined today by Dr. Richard Brian, a rheumatologist at the medical Group at Montefiore St. Luke's, Cornwall. To find out more about rheumatology, Dr. Brian. Welcome.
Richard Bryan, MD:
Oh, thank you for having me, Evo. It's a pleasure to be here.
Host:
Well, like a lot of people, I thought that rheumatism was something that afflicted people a hundred years ago, but clearly that's not true, 'cause you and I are having a conversation about this today. So tell me, what do rheumatologists like yourself treat?
Richard Bryan, MD:
Okay, well, let's try and demystify, right, because, uh—and it's very simplified definition. A rheumatologist is essentially a joint doctor, right? We deal with the joint pains that many patient's will complain of. But that's a very simplified view because joint pain really represents the tip of the iceberg when you come to think of it, right? What's going on in the joints is really indicative of what's going on from head to toe. So joint pain on many occasions is also connected to inflammation in the liver, inflammation in the heart, inflammation in the lungs, the kidneys, and other organ systems that the patient perhaps might not be aware of. So they will get up, they have difficulties rising out of bed because of the joint pain and stiffness, and that's what gets them in to see me. But there is so much more going on. So I like to think of it and describe it as the joints being indicative of the whole. So addressing the joint pain means that one therefore needs to also address the multiple other organ systems that are also being affected. So to circle back to your question. Evil, which is what is a rheumatologist and what does a rheumatologist do? Well, the way I like to describe it is as a rheumatologist addresses joint pain and the multiple complications that can arise from joint pain, and in doing so, attempt to get that patient back to the quality of life that is expected.
Host:
That's quite interesting. I had not put the connection together between a joint pain—my knee hurts, my first index finger has a little arthritis in it. Where's that coming from? And I hadn't considered the fact that it could be any place other than the joint itself that's causing it. Maybe you could help me with that. What are some of the more common rheumatological conditions that you treat?
Richard Bryan, MD:
So I try to think of it, whenever someone asks, "Tell me a bit more about joint pain, Dr. Brian," I'll say, "Well, there's a simple dichotomy: just think of joint pain that's driven by inflammation and joint pain that isn't." Now, the joint pain that isn't driven by inflammation is localized. So if someone has non-inflammatory left knee pain, well, that's just knee pain that is localized to the knee. It's not associated with anything else. So that's non-inflammatory: it's not driven by a systemic process, and that's the reason why perhaps an orthopedist will perform injections to that joint, or heavens forbid, it gets so severe to the point where that joint needs to be replaced. That's addressing a localized reason for joint pain, and that's non-inflammatory. But the other half of that coin, right? The other side of that coin is joint pain that is due to a systemic inflammatory process—systemic meaning system-wide from head to toe. So that knee pain is indicative of inflammation in the eyes, heart, lungs, liver, kidney, skin. So it's not uncommon then for one to have other complaints beyond just that left knee pain, like dry eyes or sores in the mouth or fingertips and toes changing color in the cold, or sores on the fingertips, or a rash or inflamed eyes. So it's imperative on the rheumatologist to get a very comprehensive, a holistic history, a very comprehensive history to see if there are any other organ systems in which there is a manifestation of inflammation, because that could lead us down a path that suggests that this knee pain is secondary to a systemic inflammatory condition that needs to be addressed.
Host:
And I'm assuming, and please correct me if I'm wrong, that most patients that have pain from inflammation don't really know that it's from inflammation of something. They just have pain and they need some help figuring out what that pain's coming from. Is that a true statement?
Richard Bryan, MD:
That's correct. And that's why, when they're seen by someone such as myself, we can dissect that, we can unpack it, and we can say, "Okay, this is where we need to think a little deeper," or not. But bear in mind as well, Evo, that there are also other hallmarks of inflammation, right? If someone has, let's say, knee pain, there is also warmth, swelling, redness. These are hallmarks of inflammation. So the patient will come in and they will say, "You know what? I have this subjective feeling of inflammation, but I'm also looking at it, and it certainly looks inflamed." So, yes.
Host:
Got it. That helps. So I want to talk about a couple of things before we finish here. The first one is let's talk about treatment. If my liver is inflamed and that's what's causing my right shoulder to hurt—by the way, doc, my right shoulder hurts—and we'll talk about that later. What do you do? How do you treat that?
Richard Bryan, MD:
Okay, so just to dovetail on one of the questions that you had asked earlier that I don't think I answered clearly, well, conditions that can cause these systemic findings include things like rheumatoid arthritis, lupus, and the ten lupus-like conditions; psoriasis causing psoriatic arthritis—psoriasis is a skin condition, but that skin condition can be associated with joint pain as well; ulcerative colitis or Crohn's colitis—these are inflammatory bowel conditions that can cause joint pain as well; many infections can cause systemic inflammatory joint pain like Lyme disease—everyone thinks of Lyme, but the usual culprits are like a belly bug or an upper respiratory tract infection. So these are all the conditions that can cause systemic inflammatory rheumatologic conditions. Now, to go back to the question that you just asked, which is how does one treat these conditions? Well, the underlying process is uncontrolled inflammation. So essentially potent anti-inflammatories are what are needed. Anti-inflammatories can come in a series of different potencies. We have the very weak, like Motrin, Aleve, right? These are nonsteroidal anti-inflammatory medications. We have intermediate strength disease-modifying antirheumatic drugs like methotrexate and hydroxychloroquine, Plaquenil and azathioprine and so on. And also in that intermediate-strength category, we're talking about steroids—the ubiquitous prednisone—that is much maligned simply because it has been used indiscriminately, and as a result, we see a lot of the potential complications of chronic use. But now, with the advent of the two thousands, Evo, we have revolutionized the game of rheumatology because now we have medications that are very strong anti-inflammatories, meaning they wipe out inflammation, achieving remission—not cure, but remission—and halting any additional damage from any lingering inflammation that could be going on. And these are the biologic agents that perhaps you'll see on the television. And by that I mean like Humira and Enbrel and Remicade and Cosentyx and Taltz and so on. So these are all biologic agents, biologics, simply because they are proteins that have to be refrigerated and have to be injected or infused directly into the veins in order to be active. So these are proteins, but we have taken it one step further. We now have medications that are of similar potency but are now inorganic. They're now oral options, and you'll see medications like Rinvoq or Xeljanz—maybe you've seen these on the television as well. These are medications that are of similar potency, meaning the very strong anti-inflammatories that are capable of putting someone in remission, but now, instead of needing to be refrigerated or needing to be infused or injected, now the patient can just take one tablet every day, and it works wonderfully as well. So these advances have changed the scope of rheumatology, and this is the golden age for rheumatology because these autoimmune conditions, which are essentially what the inflammatory conditions are, can now be placed in remission.
Richard Bryan, MD:
Remission, meaning a complete C of smoldering damage, so it for.
Host:
Yeah, it sounds exciting. I know people who've had lupus—I've known them for years, and in my childhood, I knew people who had lupus, is what I'm trying to say. There wasn't a lot of options for them. Now, what you were saying sounds like if you have your information about treating inflammatory rheumatoid conditions and your information is from the nineties, that's a whole new world out there.
Richard Bryan, MD:
Precisely. It's a whole new world and, in the eighties, nineties, we were content with just having someone feeling good enough to be able to perform their basic activities of daily living. "That's good enough." We're happy you can do the things you want to do with a little pain. Now, that is unacceptable because now we have the tools, we have the medications, we have the know-how to get someone to being in remission, to do the somersaults that they've always wanted to do, to go golfing and play eighteen holes and not have to limp the entire way. Anything less than that is deemed a failure. That's unacceptable with the tools that we now have at our disposal.
Host:
How does one determine if they need to see a rheumatologist? Because in my head you already know, but at some point in time you have to be diagnosed, I guess. So how does someone know?
Richard Bryan, MD:
So what generally will bring someone in to see me is joint pain. So someone—they generally jump out of bed and they can't do their activities, and then they realize that they're having increasing difficulties doing that. Well, that's a reason for them to say, "You know what? What's going on? Is this a joint issue? Is it localized to the joint only, or is there something else going on that's reason enough for them to come and see me?" But there are other reasons as well, right? If someone has a red eye, they see their ophthalmologist and the ophthalmologist said, "You know what, this is uveitis." The ophthalmologist has that heightened index of suspicion and says, "Uveitis in this person is oftentimes associated with a systemic rheumatologic condition. I'm going to send them to rheumatology." So this underscores a very important point, Evo. And that point is that community providers need to be educated and have a heightened index of suspicion for realizing when patients need to be sent to the rheumatologist. And this has been my goal, and this has been my objective, and I'm very steadfast in getting out to the community physicians and the community providers and having them be aware of when and how and why they need to send these patients over to the rheumatologist sooner rather than later. The patients, generally any kind of joint pain, will come to the rheumatologist and then we can start the workup from there.
Host:
And as you're talking, I realize I would imagine a lot of people who are being treated for these conditions might be treated by their primary care physician or others that are doing it, without getting a rheumatologist involved. How does a patient that suspects they might need to see a rheumatologist have that conversation with their community provider to let them say, "Hey, can I get a second opinion?" Is that what they're asking?
Richard Bryan, MD:
Mm-hmm. What we have going for us is that our primary care physicians and our primary care providers are very well learned and trained, and they're very good—and in this region, they are excellent. So whenever a patient comes in with complaints like those, our primary care providers will immediately think of a rheumatology consultation to help demystify some of these complaints. So all that patient needs to do is mention that to the primary care provider, and they will be referred over, and we are very accommodating as well as rheumatologists in this community. My prime directive is to be available to my community. My prime directive is to be all that I can to the patients in this community. So whenever a provider calls me up—and many of them have my cell number—they can get in touch with me at any time. Whenever they call me up or message me and say, "Listen, Dr. Brian, I have concerns about this patient. I'd like for them to come over and see you, second opinion, or just to hear your thoughts." I accept them gladly. So having that communication and being so available has made the process so much easier for us and our patients.
Host:
That is wonderful to hear. So what does a first-time visit with you look like for the patient?
Richard Bryan, MD:
A first-time visit is what we would describe as a consultation and soup to nuts. We're going through everything. I take a very comprehensive approach. I'm going to ask—I need to understand everything about the onset of the complaints. So if someone has knee pain, well, when did it start? Any trauma history? Has this happened before? I need to know all of these things. Is there any swelling associated with it? Is it worse in the evening or in the mornings? Has it ever given out? So I need to delve deep into the nature of that knee pain and of that complaint. That visit will be centered around getting all of that information, but not just that. Many of these rheumatologic conditions also have a strong genetic component, so I have to delve into the family history as well. I have to also delve into occupational history, occupational exposure. And then, after I gather all of that information, I have to do a thorough physical exam. I need to look at everything from head to toe, because as I mentioned earlier, many of these conditions don't just affect the joints. So the person may have come in to see me with left knee pain, but when I check behind the left ear, I see a dry, scaly rash. And that person tells me that, "Oh yeah, by the way, that rash has been there for the past fifteen years. It's very itchy, it gets scaly, sometimes it flakes off. I put on a topical steroid, it gets better, but then it comes back. It's never really bothered me, so I never really thought much about it." Well, the thing is, Evo, that rash could be tied into the knee pain, because that rash could, in fact, be psoriasis. And we know that forty percent of patients with psoriasis can have psoriatic arthritis, and psoriatic arthritis also loves the knees. So now I'm putting it together, so I get a thorough history, a thorough physical, and now I'm trying to unify the complaints, right? Because you don't want to have ten different complaints with ten different diagnoses. Oftentimes you can have ten different complaints that can be unified by two different diagnoses if you are thinking in the manner in which one should.
Host:
This is an amazing bit of information, 'cause I think people don't quite understand how much things have advanced in the process. Before I let you go, anything else you would like to add?
Richard Bryan, MD:
So, Evo, it's education. I spend a lot of time educating my patients, because I find that an educated patient—a patient who knows one, what their diagnosis is; two, what the plan is; three, what the expectations are; and the fact that they will be recruited in their healthcare—that makes my job so much easier. And I spend a lot of time educating my patients about what it is that I'm doing and what their condition is, because they have to be their strongest advocate. And the more they know, the better they can advocate. Now, in this day and age of social media and information at our fingertips, it's not uncommon for me to have patients coming in and they've done all this reading and they've done all this stuff, and they have a wealth of information. Well, I generally welcome that, because my job is to distill that information and for that information to make sense to them. They've already taken the initiative to get that information. Now I try to distill it, and they leave feeling edified.
Host:
Dr. Ryan, thank you very much for all the information today.
Richard Bryan, MD:
No, no, the pleasure is all mine, and I'm so glad that you could take the time to chat with me today. Thank you.
Host:
You're welcome. Thanks once again to Dr. Brian for all of this fantastic information and good news today, and thanks to you for listening to Doc Talk presented by Montefiore St. Luke's Cornwall. To learn more about rheumatology services as well as other specialty and primary care services, please visit slc med group.com. I have been your host, Evo Terra. Please remember to subscribe, rate, and review this podcast and all the other Montefiore St. Luke's Cornwall podcasts. Thanks for listening.
