Hooked on Rheum with Kathryn Dao, MD
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I did not choose rheumatology — it chose me.
My first inpatient rotation at Barnes-Jewish Hospital, in St. Louis, was as an intern with Wayne Yokoyama, MD, who was chief of the rheumatology division. We were on the general medicine wards seeing patients hospitalized with various diseases. He taught me how to tap an ankle joint, correct hypocalcemia and triage patients to the ICU.
I had a great rotation and did not think about rheumatology as a specialty until he called me to his office during my second year of residency, which is the time to choose electives and start the application process for subspecialty training.
Near the end of my second year, I was leaning toward being a gastroenterologist. I enjoyed doing procedures, and the gastroenterologists seemed happy. I had even approached several gastroenterology attendings about applying to the program, but then I received a page: Dr. Yokoyama needed to see me immediately. I was sweating bullets that I must have killed one of his patients.
When I arrived at his office, he told me I am going to be a rheumatologist. It really took me by surprise because rheumatologists deal with enigmatic, complicated diseases. He promised me that this field is stimulating, and I have what it takes to be one.
Rheumatologists are considered the super-internists. They have to be knowledgeable in all fields of medicine, from cardiopulmonary diseases, gastroenterology, neurology, dermatology, nephrology and orthopedics. Often, a patient will be referred to rheumatologists because all the other doctors are stumped. They are the Sherlock Holmes of medicine.
On that day, Dr. Yokoyama handed me a packet. It was my application for a rheumatology fellowship. He had already filled out some of it.
If there was one other influence on my career, it was my rotations with infectious diseases, gastroenterology, endocrinology and outpatient rheumatology with Rick Brasington, MD, of Washington University in St. Louis. He taught me the very important lesson that it is often crucial to tell patients what they don’t have, especially when you do not know what the diagnosis is. Many patients are relieved to hear they do not have lupus, vasculitis or cancer. Because some rheumatic diseases can take years to manifest fully, Dr. Brasington suggested it is best to say, “Today, you don’t have [blank].” This is a lesson I still use daily in my clinical practice.
The interactions with Drs. Yokoyama and Brasington changed the course of my life. This summer, I celebrate 20 years in rheumatology. You can follow me on Twitter at @KDAO2011 and on TikTok at Rheum101.
Kathryn Dao, MD
Associate Professor
Department of Internal Medicine
Division of Rheumatology
UT Southwestern Medical Center