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Patients And Their Clinicians Are Best Placed To Comment

Respondents

Eric Last

Carly Flumer

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Doctors need to be confident if they are to be effective

Respondents

Eric Last

Kimberly Warner

Daniel G Garza

Carly Flumer

BJ Miller

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Patients notice small details

Respondents

Eric Last

Carly Flumer

Ann Graham

Daniel G Garza

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Can doctors do something about the wait?

Respondents

Dr. Eric Last

Carly Flumer

Dana Deighton

Daniel G Garza

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Telemedicine is here to stay but how and why?

Respondents

Eric Last

BJ Miller

Kimberly Warner

Carly Flumer

Rod Ritchie

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How we say it matters as much as what we say

Respondents

Eric Last

Carly Flumer

Kimberly Warner

Dana Deighton

Rod Ritchie

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Tests maybe routine but are not always necessary

Respondents

Eric Last

Dana Deighton

Carly Flumer

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Doctors advised to send birthday cards

Responses by

Eric Last

Carly Flumer

Soojin Jun

Daniel G Garza

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Scans and X-ray requests convey something to the patient

Respondents

Carly Flumer

BJ Miller

Eric Last

Mike Rabow

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It’s not the symptoms, it’s the context.

More on the Art of Doctoring in my conversation with the one and only Baktash Ahadi

Objective. People with RA have episodes of worsening disease activity (flares) that prompt them to seek clinical review or medication change. This study explored patients’ perspectives of flare that prompts them to seek medication review.

Methods. Fourteen focus groups across five countries comprised 67 RA patients. Transcripts were analysed by several researchers and a patient, using inductive thematic analysis.

Results. Patients use flare for five different scenarios, including flare that prompts medical help-seeking, where six themes were identified. In ‘Symptoms and early warnings’, pain is intense (wanting to die), constant and persistent and considered a key feature. Systemic features predominate, including fatigue, feeling generally ill (flu-like), physical and cognitive shut-down and social withdrawal. Warning signs (prodrome) comprise fatigue and flu-like symptoms. ‘Self-management of intensifying symptoms’ includes pacing, heat/cold, rest and increasing medication, often without medical advice. Patients ‘Define this as uncontrollable flare’ when clusters of unprovoked, persistent symptoms halt their ability to run daily life, until prompted into ‘Seeking help when symptoms can’t be contained’. Underpinning themes are ‘Individual context’ (e.g. different symptom clusters) and ‘Uncertainty’ (e.g. when to seek help). Patients report that the current patient global visual analogue scale (VAS) does not capture flare.

Conclusion. Patients use flare for multiple events and seek help for complex clusterings of intense, unprovoked symptoms that defy self-management, not necessarily captured in joint counts or global VAS. Flare terminology and definition have implications for clinical practice and trials, therefore further research should establish a professional/patient consensus.

Hewlett et al

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