Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Rheumatol. Mar 12, 2016; 6(1): 1-8
Published online Mar 12, 2016. doi: 10.5499/wjr.v6.i1.1
Return to clinical in contrast to serologically-based diagnoses
Bruce M Rothschild
Bruce M Rothschild, Department of Medicine, Ohio Medical University, Rootstown, OH 44272, United States
Author contributions: Rothschild BM solely contributed to this paper.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Bruce M Rothschild, MD, FACR, Professor of Medicine, Department of Medicine, Ohio Medical University, 5500 Market Street, Rootstown, OH 44272, United States.
Telephone: +1-785-6151523 Fax: +1-724-4272707
Received: June 8, 2015
Peer-review started: June 10, 2015
First decision: September 18, 2015
Revised: September 23, 2015
Accepted: November 13, 2015
Article in press: November 17, 2015
Published online: March 12, 2016

The future of rheumatology is predicated upon a return to basics. The advent and facile availability of laboratory testing led to reduction of emphasis on clinical skills. Recognition that immunologic abnormalities are not limited to individuals who clearly have related pathology provides new motivation for reorientation of training programs to assure that graduates have appropriate information gathering, diagnostic and procedural skills. Inadequate accessibility to rheumatologic care requires innovative approaches and especially training and educating those individuals who provide primary care. While the rheumatologist can elicit the patient’s history remotely, telerheumatology will be feasible only when the individual interacting physically with the patient has confidence in their examination skills and when those skills have been validated. Named syndromes or diseases will be modified to avoid impugning the individual or compromising their future access to health, disability and life insurance. Interventions will be pursued in a more cost-effective, evidence-based manner. The future of rheumatology is dependent upon the rheumatologist’s ability to amortize the inadequate reimbursement for direct patient interaction, depending on skills of interpretation of standard X-rays, ultrasound performance and results.

Keywords: Laboratory test, Immunology, Procedure, Telerheumatology, Nomenclature, Radiology, Ultrasound

Core tip: Rheumatology started as a clinical practice, dependent on skills of eliciting pertinent history, performing complete physical examination and recognition and interpretation of radiologic findings. Laboratory testing has distracted from those origins and it is time to return to those basic skills.