The Rheumatology Clinic at The Salvation Army Toronto Grace Health Centre has now been operating for over two months. Dr. Raphael Rush, the rheumatologist who runs the Clinic, is pleased because the Clinic he envisioned is able to help and support patients admitted to Toronto Grace, as well as patients directly from the community.
Dr. Rush completed his M.D. at Queens University and pursued training in internal medicine and rheumatology at the University of Toronto. He is on staff at Toronto Grace as a hospitalist, most responsible physician and consultant, as well as at the Sinai Health System.
Setting up a Rheumatology Clinic has been a goal of Dr. Rush that he has cultivated since completing his rheumatology fellowship. I was able to speak with him about joining the medical staff at Toronto Grace and how the Clinic became a reality.
Dr. Rush how did your interest in internal medicine and rheumatology come about?
Dr. Rush: One of my interests was learning to take care of patients who had complex and chronic diseases who did not necessarily need to be in an acute care setting, but who really needed the attention an internist and rheumatologist can provide.
An internist is a doctor of internal medicine what do they specialize in?
Dr. Rush: An internist specializes in the diagnosis and treatment of adults. Internists manage common and complex diseases such as hypertension (high-blood pressure), diabetes, lung and heart disease and infections.
…Like some of the patients are diagnosed with here at the Toronto Grace?
Dr. Rush: Exactly. Internists often take care of patients with complex diseases until they no longer require the services of an acute care hospital. Then their destination becomes a rehabilitation facility or it can sometimes be complex continuing care, services we have here at Toronto Grace. But once patients are admitted here, they often still benefit from being seen by an internist.
What does a rheumatologist specialize in?
Dr. Rush: A rheumatologist specializes in arthritis and autoimmune diseases that affect the joints. An autoimmune disease is a condition in which your immune system mistakenly attacks your body. Some of the diseases a rheumatologist treats include osteoarthritis, rheumatoid arthritis, psoriatic arthritis and lupus. We treat over a hundred different kinds of conditions.
How did you choose to work at Toronto Grace?
Dr. Rush: After I did my training in internal medicine and rheumatology I investigated rehabilitation centres like Toronto Grace. I was very interested in the many programs it offers such as Post Acute Care Rehabilitation where patients are treated for acute medical conditions, neurovascular diseases, musculoskeletal related illness or injury and complications affecting motor functional and cognitive skills. Many of the patients also have problems an internist or rheumatologist might see.
Toronto Grace’s Complex Continuing Care (CCC) program – where I am now one of the hospitalists and most responsible physician – we work with patients that have complex medical conditions and disabilities, where their complex care needs exceed the capabilities of care in the community.
Were you impressed with the programs here at Toronto Grace and the quality of care their patients received?
Dr. Rush: Absolutely. The health care team at the Toronto Grace works hard treating patients medically and physically so that they are able to gain back their independence to the point where they can live their life as fulfilling as they possibly can, and hopefully return home or back to the community. These are the things Toronto Grace does in a unique way. Toronto Grace felt like it was natural fit for my interests and I felt lucky that the Toronto Grace felt that I might be a good fit as well.
You were in agreement with the Toronto Grace to set-up the Clinic; were you also in agreement about its purpose?
Dr. Rush: One of the things we talked about when I was first interviewed was the prospect of setting up a Clinic. We clearly envisioned the Rheumatology Clinic as having two purposes. One was to provide follow-up care for patients who had left the Toronto Grace but still might need the services of a rheumatologist, as patients’ medical needs don’t stop the minute they leave the hospital.
The Rheumatology Clinic is also open to patients all over Ontario. By seeing people with rheumatic diseases early and effectively managing their rheumatic conditions, we can help prevent them from being admitted to a hospital in the first place. I feel this aligns perfectly with the Grace’s vision of exceptional and compassionate care for all.
Dr. Rush would you say that the treatments for arthritis and autoimmune conditions patients receive today have improved significantly in the last thirty years?
Dr. Rush: Absolutely. Thirty years ago a large hospital here in Toronto might have had entire floors devoted to patients who had bad arthritis that hadn’t been treated. In the last thirty years there has been a real revolution. Treatments have gotten so successful at preventing the complications of diseases like rheumatoid and psoriatic arthritis that nowadays most rheumatologists are able do most of their work in a clinic.
Can arthritis cause problems in the rest of the body?
Dr. Rush: Rheumatoid and psoriatic arthritis, for example, are forms of arthritis that are caused by problems with the immune system. The immune system is designed to fight off foreign invaders. Sometimes the immune attacks a part of the body as if it were a foreign invader. Arthritis, psoriasis, Crohn’s and ulcerative colitis are all examples of conditions like this.
The immune system will often attack multiple systems at once. Although patients are referred to me with arthritis, I will often look to see if any other systems in the body are involved.
How does the Rheumatology Clinic integrate with the other outpatient clinics Toronto Grace offers?
Dr. Rush: Our Rheumatology Clinic at Toronto Grace works closely with the Chiropody Clinic. The Chiropody Clinic treats patients with foot problems. In the Rheumatology Clinic we look at problems with all the joints of the body. The two clinics are both a natural complement to the inpatient and the outpatient services we offer. If a patient visiting the Chiropody Clinic has a musculoskeletal issue like arthritis then they can be referred to the Rheumatology Clinic, and if rheumatology patients have foot problems we can quickly involve our chiropody team.
Good to know.
Thank You Dr. Rush.
By Gerry Condotta
Contact information for Toronto Grace’s Rheumatology Clinic