Case-Based Approach for the Management of Rheumatic Diseases - Episode 16
Transcript: Grace C. Wright, MD, PhD: If you don’t have access to a therapy, it can’t work for you. One of the big issues we face is just getting drugs to patients if their insurer doesn’t cover this or it’s a very high co-pay, so the patient can’t afford that. There are multiple strategies that have allowed that to happen to patients, where their out-of-pocket cost is hundreds of dollars a month. That is not helpful. It’s not beneficial. The sad part is that if I don’t get this 31-year-old under control, she’s going to drop out of the workforce because she’ll be so damaged and destroyed. And when her joints are damaged and destroyed, I will have very little to offer besides trying to replace them. If I want to think about her for not just the next 6 to 18 months but 60 years, then it behooves me to control her disease. This idea of having access to therapies is critical—access to therapies that can be tolerated. It’s possible that I can say, “Well, I’ll give you 3 of these things, or you’ll take 7 tablets in the morning, 5 at night.” Nobody is going to say it’s not going to succeed. It’s accessible, but it’s not sustainable. It’s access and sustainability that have to go hand in hand, and if we don’t have that, we don’t control this disease. We don’t control this class of diseases, and we have an entire group of young people who get removed from the workforce—forget the workforce, they get removed from their lives. There’s no joy. There’s no fun. The family, the children, all the things that would normally bring a human pleasure—we’re really removing that from their lives. This is a huge unmet need, and we have to fight to always make sure that therapies are accessible the patients who need them.
It’s really important, when we’re in the community and treating patients that we make it our job and our primary goal to hear them. To listen to them. She’s telling you that she’s almost dropping her child, she can’t keep a clean home, she probably can’t stand up to cook a meal. That’s affecting not just her but her entire grouping, her entire social structure. If we start to hear that, we can say, “Well, the job is to get her functionality.” Not just to say, “I’m going to put you through step 1, then step 2, then step 3.” Hear her, hear him, understand what the problem is, and then there are all these resources to help us walk through and figure out the next-best step. Patients are very good at saying what doesn’t work for them. They may not be able to quantify, but they can say, “That makes me feel really awful.” They don’t know what awful is, but awful is just not a good place to be. Or they’re very nauseated, or they’re very depressed, and they can’t get up and go to work because it takes them 4 hours to get dressed and go out. We need to listen. And a listening ear then becomes a thinking brain that becomes and effective prescriber. It’s all tied together, and that’s really something that we just always remember. Listen, listen, listen. Then consult. If you don’t know it, ask somebody else. There’s a rheumatologist somewhere who will have an answer to share. We love to talk, we love to share, and we love to help. So find somebody. We’ll be there.
Transcript Edited for Clarity