Who is a rheumatologist? The Identity crisis of a rheumatologist in India!

Dr.Benzeeta Pinto, Asst. Prof Clin Immunology & Rheumatology, St John’s Med College, Bengaluru

The results had just been declared and I stared at the board bearing my name in disbelief. I had just cracked another entrance and hopefully this would be my last one. DM Rheumatology! After two years of trying I had finally made it into the course. I was over the moon and went home to celebrate my success with my dear ones, picking up some samosas and jalebis from the nearby Gopal sweets (Yes, there’s one in every city). Our tea party was soon interrupted by Mr and Mrs Nosy Parker (Yes, there’s one in every Indian neighborhood!) who were our neighbors and needed no invitation. Mrs Nosy felt entitled to knowing every little detail of my life and was a bit disappointed that she found out so late. ‘Congratulations beta’ uncle said, and aunty nodded. “DM Rheumatology,”she said emphatically.

Vaise what is rheumatology? This wasn’t the first time this question was thrown at me. Most times I would reply briefly saying it pertains to the joints and immune system,but today was different. I was in the presence of a small audience felicitating my formal induction into this field and I felt the responsibility to inform them about my choice. “Aunty, we treat diseases that are immune mediated ,sometimes the immune system which protects our body goes on an overdrive and attacks itself. You must have heard of rheumatoid arthritis, joints get swollen and painful.” Uncle looked at me confused.

“How many years is your course?” he asked. “Three years, just like Cardiology and Neurology,” I replied, mildy irritated by now. Cardiology and neurology always get instant respect. The heart, brain, kidney, and liver were vital, and this was simple enough for any lay person to understand. Even the most educated of my friends were clueless about rheumatology. Most didn’t even realize that this was a medical branch and not an orthopedic subspecialty. “You need three years to learn to treat one disease?” Uncle asked, refusing to let go. The expression of my family members had nowchanged from pride to concern.

My visibly worried maternal uncle asked me, “I hope you will be able to get a good job.” In the two years that I had prepared for entrances, nobody had really doubted my choice. After all, in my extended family, I was an academic hero. The studious nerd who was displayed as a good example, much to the envy of other inferior mortals. A bit red-faced I began explaining that there were a vast number of diseases that were caused by problems in immunity. “Rheumatoid arthritis is the commonest disease we treat uncle and it affects 1% of the population but it’s not the only one,” I told him defensively. I was naïve after all, little did I realize that rheumatologists were not the only ones treating RA. “But B you are so smart, why didn’t you choose to specialize in the brain, heart, or kidney” one of my non-medico friends quipped. I gave up! My moment of glory had ended quite prematurely. “Have some more jalebis, Gopal’s makes the best jalebis.” I swallowed my pride and changed the topic of discussion to the less controversial jalebis. After all the joints or even the wonderfully complex immune system is no match to the brain, heart, kidney or gut. I went to OPD the next day and a patient asked to see “Jodwala doctor”.

Hmmm… I liked the sound of that, “ Jodwala doctor ” was so much better than “gas wala doctor” or “ peshabwala doctor”.

(No offence to my gastroenterology and urology colleagues, who are, of course, laughing all the way to the bank while I wait for my patients who are being treated by orthopedic surgeons, physiotherapists, faith healers, and grandmothers with exotic home remedies.)