A POINTOF VIEW The Merits of an Evening Arthritis Clinic BY HARRY BARTFELD, ROBERT BROWNAND ESTHERBIGUS T HIS REPORT COMPARES VARIOUS FEATURES of the Bellevue Hospital 3rd Division Evening and Afternoon Arthritis Clinics of the New York University Medical Center, Rheumatic Diseases Study Group. The Rheumatic Diseases Study Group initiated an evening clinic (E.C.) with two purposes in mind: (1) to serve the convenience of patients who are employed and ( 2 ) to enable medical students to attend for a full year without interference with their other daily assignments. Following a series of conferences with Dr. Currier McEwen and the Heads of the Bellevue Hospital O.P.D., it was decided to have this clinic on Thursday Evening since the Evening Cardiac and Cardiovascular Clinics meet then and the ancillary services of xray, pharmacy, and routine laboratory services would be available. In 1962 University Hospital (formerly New York Post-Graduate Hospital) moved to a new site and therefore abolished or transferred its clinics to Bellevue Hospital. The Arthritis Clinic of University Hospital was begun by Dr. Edward Hartung and had a tradition of postgraduate teaching in the rheumatic diseases. The original staff of the 3rd Division E.C. was that of the former clinic at University Hospital whose chief was Dr. Harry Bartfeld, and some of its patients served as a nucleus of the E.C. The first session of this clinic on May 10, 1962 had only one patient, a diagnostic problem. She had an outgoing personality, worked as a beer saleswoman, and although she had no frank evidence of arthritis, she had a positive latex fixation test. A nodule removed from the metatarsal plantar area of her foot was histologically a typical rheumatoid nodule. Following a workup by the six clinic attendings, she was necessarily our first conference case. Now this clinic generally has from 15 to 22 patients each week, with 2 to 4 new cases at each session. The Friday Day Clinic has a great tradition. It was begun by Dr. Currier McEwen in 1932 and later became part of the Rheumatic Diseases Study Group. It has subsequently had as its chiefs, Dr. Joseph Bunim and Dr. Morris Ziff. As it grew, it was divided into the Tuesday Morning Clinic, whose chief is now Dr. Edward Franklin and the Friday Afternoon Clinic (A.C.), whose chief is Dr. Robert Brown, and whose staff consists of Attendings and Fellows of the Group. The E.C. staff consists of Attendings, most of whom are former Fellows of the Group. The E.C. meets from 5 0 0 to 8:OO P.M. Patients are seen until 7:OO. A conference follows. The E.C. has a staff of seven physicians. The A.C. meets from 1:30 to 4:30 P.M. and also has a weekly conference. It has a staff of six physicians. Both clinics have the services of the same secretary, Mrs. Esther Bigus, and an Ancillary Staff consisting of a physiatrist, a physical therapist, a laboratory technician, and a nurse. On From the Rheunzatic Diseases Study Group, Department of Medicine Belleoue Hospital 3rd Division, New York University Medical Center. HARRYBARTFELD,M.D.: Associate Professor of Clinical Medicine, New York University Medical Center, Associate Visiting Physician Bellevue Hos- pital. ROBERTBROWN,M.D. : Assistant Professor of Clinical Medicine, New York University Medical Center, Assistant Visiting Physician Bellcvue Hospital. ESTHER BIGUS,A.B.: Senior Clinic Secretary, Rlat?unmtic Diseases Study Group, New York University Medical Center. 74 ARTHRITISAND RHEUMATISM, VOL. 9, No. 1 (FEBRUARY), 1966 75 MERITS O F AN EVENING ARTHRITIS CLINIC admission to either clinic patients receive the following tests-complete blood count, urinalysis, erythrocyte sedimentation rate (Westergren), C-reactive protein, latex fixation test, LE cell and antinuclear factor (by the fluorescent method) tests and serum uric acid. Other biochemical tests and sensitized sheep erythrocyte agglutination and inhibition tests for rheumatoid factors are done as required. Both clinics are aided by grants from the New York Chapter of the Arthritis Foundation. The attendance of physicians and the number, sex distribution, age, working status, diagnoses, and attendance of the patients in the 2 clinics were compared. Physician attendunce. A study of a five month period showed there were no absences in the E.C. and 5 absences in the A.C. During the four month period between April and July 1964, the data on individual patients were accumulated and are summarized. The number of patients does not include revisits. Number and sex distribution. E.C. had a total of 90 patients evenly divided between men and women. A.C. had a total of 159 patients, of which 69 per cent were women and 31 per cent were men. Age distribution. The greatest number of patients in the E.C. were between 30 and 39 and 50 and 59 years of age, whereas the A.C. had its greatest number between 50 and 59 and 60 and 69 years of age. There were twice as many patients in the A.C. over 70 as in the E.C. Patients working. About half the patients in the E.C. were working, compared to only 13 per cent of the A.C. patients. The A.C. serves those patients who are older, are unemployable, or too infirm to work. The E.C. serves those who are continually working. Also, some of the women who attend the E.C. cannot come during the day and must wait until the evening for their husbands to mind the children or for their husbands or children to bring them. Diagnoses. One-third of each clinic population consists of rheumatoid arthritis patients. Percentagewise, the E.C. saw twice as many ankylosing spondylitics. About 33 per cent of the patients attending the A.C. had symptomatic osteoarthritis, but only 17 per cent of the E.C. had osteoarthritis. Patients Attendance. The total number of patients seen during this period was 273 for the E.C. and 402 for the A.C. There were 30 new patients for the E.C. and 42 for the A.C. Appointments missed were about equal for both clinics. Conferences and Medical Students. The weekly conferences following the clinics are generally divided between patient presentations and seminars in which a physician discusses a different topic in the field to bring everyone up to date. In addition, the Evening Clinic serves to train and teach medical students. There are generally one to three students attending for periods up to a year. Some of these students are also involved with projects in the research laboratories of the Group. We are the second Evening Arthritis Clinic in New York City. French Hospital began one in 1956 with Dr. Emmanuel Kudd as Chief. Many other American cities have evening cardiac clinics and their ancillary services could also function for arthritis clinics. SUMMARY Our experience suggests that some patients need an evening arthritis clinic and that often the physician can function in such a clinic with greater ease because the responsibility of daytime practice, teaching, and other commitments are not present. BARTFELD, BROWN AND BIGUS SUMMARIO IN INTERLINGUA Un comparation inter un clinica de arthritis de vespere con un de die revelava que plus subjectos de etate avantiate visitava le clinica de die e plus masculos visitava le clinica de vespere. In le vespere, 50 pro cento, sed in le die, solmente 13 pro cento del patientes travaliava a base professional. Le procentage de patientes con arthritis rheumatoide esseva equal in le duo clinicas, sed plus patientes con spondylitis ankylosante e con gutta visitava le clinica de vespere e plus patientes con osteoarthritis le clinica de die. Le presentismo de medicos a1 clinica esseva melior in le vespere. Clinicas de arthritis in le vespere e in le die servi differente segmentos del population de patientes arthritic.