I interviewed my Italian friend Valentina a few months ago about what it’s like being a rheumatologist and working in the field of rheumatology in Europe, and in particular in Germany. Valentina, or Dr. De Angelis I should probably call her, happily agreed to answer some questions for me to share with others who are also curious about what’s going on in rheumatology outside of the United States. She lives in Cologne, Germany and works as a rheumatologist in a private practice there.
Here’s a link to her practice’s website (if you happen to read German!) – Rheumatologie Centrum
How did you get interested in working in rheumatology?
I decided I wanted to be a rheumatologist when I was in my fourth year as a medical student. I liked rheumatology because of the complexity of the diagnoses and management of patients. As a doctor you don’t get bored visiting rheumatologic patients, because of the diversity of their symptoms and the variety of diseases there are. Nothing is standard and improvisation is often required (Italians like that a lot!). I like to treat patients with chronic diseases because I get to know them as people and not only as numbers or hospital files. I’ve also always loved research and with autoimmune diseases there is still a lot to discover–in understanding the pathologic pathways and the development of new therapeutic strategies.
What are you doing right now? Please explain the details of where you work, the work you are doing, the types of patients you have. What does your day typically look like?
I work in a private practice, which means I start at 8:00 in the morning and see an average of 30 patients every day. I see returning patients for 15 minutes and new patients for 30 minutes. In addition to the patient visits, I have to answer questions over the telephone that our patients may have (about therapies, about the disease, about side effects of the medications) and I have to check the multiple laboratory results that we receive from the patients’ GP (general practitioner) doctors. My patients, because of their therapies, have to check their blood values very often to avoid complications.
I see all types of rheumatic diseases, with a high prevalence of rheumatoid arthritis. This also means that we see patients of every age, from the very young to the very old.
What are your patients like, in general? Age, gender, type of disease?
We have mostly women, of any age. Rheumatoid arthritis mostly, but also vasculitis, connective tissue diseases, polymialgia rheumatica, and fibromyalgia. We also see a lot of patients with simple cases of osteoarthritis (OA) who are then advised to go to see their GP physician, an orthopedic specialist, or receive chronic pain treatment.
What types of treatments do you usually prescribe for your patients? How well do they usually work?
In Germany the guidelines for private practices are quite strict and we tend to follow them as much as possible. But, as I said before, this is sometimes impossible with autoimmune diseases (because of how they can affect each patient differently). The medications are different for each patient according to his or her diagnosis. The therapies can also be influenced by contraindications (for example, patients with hepatic diseases), so it is quite difficult to generalize, although the most prescribed medication at the moment is definitely Methotrexate, which luckily still works well enough to control most of the “routine” cases in our practice. Unfortunately, there are some patients who do not respond well to Methotrexate or have bad side effects from it. In these cases we have to start switching to other medications, which usually means using the “biological therapies.” It’s difficult in these cases to keep the trust of our patients (we know what we are doing, even if it doesn’t look like it!) and to avoid them feeling like a laboratory animal (as some patients may think after the third medication attempt!).
What challenges do you face with your work? Challenges with patients? Within the medical community?
Sometimes it’s very difficult to feel trusted by patients, especially when the classic medications don’t help immediately and we have to switch and try other medications until we find something that works–which can be very different for each patient. They sometimes feel like they’re animals being experimented on, or they think we’re just trying out different things and actually have no idea what to do!
Plus, we need to support the patients not only with medication, but also psychologically. Having a chronic disease is already a challenge for them. Having a chronic inflammatory disease, that can cause daily pain and has to be treated with strong medications that can drastically change their lifestyle and also sometimes their physical appearance, is definitely more than a lot to handle–especially for young people.
Another challenge is that some other doctors are scared to use immunosuppressant medications and tend to transfer this fear to our patients. Sometimes we need time to calm them down and explain to them again and again the importance of using these medications.
Are there any changes that you would like to see happen in the field of rheumatology? If so, what are they?
It should be easier to prescribe biological agents when appropriated, without thinking of the economic consequences.
What are your professional and personal goals as a doctor working in your field?
To bring the disease into remission as soon as possible for my patients and without the use of cortisone (steroids). To improve the quality of life of my patients.
What advice would you give patients who have RA? What advice would you give people who do NOT have RA or arthritis (families, friends, coworkers, etc.)?
To the patient: Trust your rheumy! We work for your best health!
To the family: Go with the patient to his or her appointments and try to understand what a rheumatic disease is. Inform yourself in order to understand your loved one, because that’s the best way you can help.
I’d like to say a big THANK YOU to Dr. Valentina De Angelis for taking the time to answer my questions and to translate her answers into English for us all. The next time I go to Germany, I know who I’ll have take care of me while I’m there!