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The merits of an evening arthritis clinic.

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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.
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