Rheumatology is not an every day ordinary word. Let’s face it, it didn’t make the rounds on the school yard, and probably barely hits the office water cooler conversations. For years when people would ask me what I did I would resign myself to saying ‘oh just doctor…’ and wait for the conversation to move on.

I recall one time when I was in a boutique shop, buying clothes (FYI and BTW it was an awesome totally hot red jacket…), I formed a lovely relationship and rapport with the lady selling me the clothes. I liked her, she liked me, it was rocking. As she was packing up my jacket she asked me ‘so what do you do’. I thought, for once I’m going to say what I do, so I said confidently ‘I’m a Rheumatologist’ and I waited for the expected ‘Oh. What IS that exactly?’ and I was ready to explain.

However, she surprised me completely by going ‘Darling that’s amazing!’ and I thought to myself, feeling pretty pleased, yes it is actually but how do you know? And then she said distractedly whilst I was feeling chuffed someone not only knew what I did but appreciated it (all the while looking forward to putting on my red jacket)…she said ‘So… you rearrange space’ (um was she speaking metaphysically?, and I pondered for a moment whether that was in fact what I did….) and she continued ‘so you rearrange rooms, that’s fantastic!’ and it slowly dawned on me that she thought I was a ‘Room-atologist’…… Aaah no, we don’t rearrange rooms, or furniture, just bodies!

So what exactly does a Rheumatologist do?

Rheumatology comes from the Greek word ‘Rheuma’ which means flows like a river. No, we don’t deal with waterways or waterworks, we actually deal with the musculoskeletal system and connective tissue of the body. If you think about it, when the body is well, it is ‘in the flow’ and when our bodies are stiff with illness disease and arthritis they are definitely not in the flow so to speak.

As Rheumatologists, we treat many conditions ranging from autoimmune connective tissue diseases such as Lupus, and complicated autoimmune disease affecting multiple organs to conditions such as Arthritis, such as Rheumatoid, Gout and Psoriatic Arthritis – btw did you know that there are more than 100 different types of arthritis?! – and issues affecting the body such as pain in different areas, such as back pain, shoulder pain, knee pain, wrist pain etc. We are the diagnosticians. If someone is unwell, and there is no obvious cause for it, people come and see us. We investigate why people have pain, not just treat the fact that they have pain. If you know the source of pain, there is the possibility that there are potential treatments. We are thorough, and we are comprehensive.

My day can range from dealing with the most simple thing such as the typical sore toe (a real problem by the way and one I love treating!) or Gout (which I also love treating) and easily controlled Arthritis to the more complicated cases of conditions that are not responding to known treatments, to diagnostic dilemmas where people have no obvious cause for their multiple symptoms and need a full and comprehensive evaluation. I really enjoy these cases, in particular where people have been confused and not given answers anywhere else. I love getting to the bottom of things, and making things simple.

I love establishing foundations of understanding for people. There are a lot of complex health issues out there and it can be challenging to know what to believe from what you read, or what is true and people have a lot of concerns which is understandable. What I really love about my day is explaining to people what is going on, supporting them to get foundations of understanding that then help them come to terms with, if not understand, what is going on in their health care.

In Rheumatology, much of what we see can be quite complicated. There is no simple ‘one fix all’ and people often have conditions that take time to get under control with medications, and whilst we have medications that are effective for many conditions, they do not come without their potential side effects, like all medications. I love helping people to understand their conditions, their medications and what options are before them, and empowering them to make their own choices.

We don’t always have answers in Rheumatology for peoples’ health care conditions and sometimes people come and see us with complicated patterns of symptoms. We know that people are not well, but sometimes there is no Rheumatological cause for their problems. Often people are dismissed if they don’t have a ‘diagnosis’ for their feelings of being unwell and it is quite disheartening as we all know when we are not well. What I love doing is appreciating and validating that people are not well, even if nothing shows on ‘tests’. Because nothing comes up on any of their ‘tests’ people are often told that they are ‘normal’ or that awful phrase ‘nothing is wrong with you’. Tests don’t show everything because we don’t have ‘tests’ for everything. We all know when we are not ‘right’ and this needs to be honoured.

I find what really helps people is to investigate people extremely thoroughly for anything that is known that may cause their symptoms, especially Rheumatologically. In that thorough assessment we may find something, and if we don’t, knowing what it is not is very reassuring and gives people a solid medical foundation as to what is and more importantly what is not going on that tells them that they do not need medical treatment. It is reassuring at least to know that you don’t need drugs to treat what you are feeling and lays a foundation to explore other things as needed.

Often in medicine as doctors we feel helpless and hopeless when we are unable to offer people an immediate solution to their issues. It is natural and innate in us as caring people to want to help people and take away their pain and suffering. However, medicine has its clear limitations. Whilst the knowledge of medicine can have its clear limitations, our care and our ability to connect with people does not. It makes a big difference to us the way that we care, the way that we connect with people, and the way that we listen. We might not know what the cause of a persons ill health is, and that does not reflect poorly on us as we can only know what we know, but the fact that we listen, take it seriously, and do not dismiss it makes a huge difference to the person sitting in front of us and this is one of the huge differences that I make in my daily job. I care and I hear.

Rheumatology offers amazing treatments for conditions that are extremely debilitating without these treatments. The field has transformed in the last 20 years with great outcomes for inflammatory arthritis such as Rheumatoid with new treatments. I love being able to support people through their conditions by supporting them to understand their medications, and how they can best support their health care.

More than the treatments that I provide, I love the interaction with people. The care that I am and have with people and my thoroughness in doing my best to get to the bottom of things makes a big difference for people and is something that I share with all doctors and medical students. Being who you are and the care you are and the connection you have with people makes a bigger difference than you will ever know whether its in an awesome specialty like Rheumatology, or elsewhere.

Dr Maxine Szramka MBBS Hons 1, B Med Sc, FRACP is a Rheumatologist practicing in Sydney. She works in full time private practice. In addition to that she directs a private research council, sits on the editorial board of an international peer reviewed rheumatology journal, and is a clinical senior lecturer at the University of Wollongong, a mentor for medical students and is involved in a number of community volunteer projects. She is a sought after educator with an ability to take the complex and make it simple – and fun!

As well as caring for her patients’ health and well-being, Maxine is passionate about the health and well-being of doctors including the plague of burnout! She writes and presents on these matters, and also blogs at drmaxine.com.au on medicine, science and society – no medical advice on this site! Opinions only!

More articles on My Health Career:

• Doctor burnout begins younger than we think – Dr Maxine Szramka
• What do you want to be when you grow up? Re-writing the answer to the age old question – by medical student Stephanie Pommerel
• The best and worst of a career in medicine
• What sort of doctor do you want to be? Medical specialties