Dubai Rheumatologist

One day I will write a book titled:
"The Closing of the Doctors' Minds: How the Misuse of 'Classification Criteria' as 'Diagnostic Criteria' in Clinical Practice Contributed to the Suffering of Thousands of Patients."

In clinical practice, we've witnessed a growing misuse of classification criteria — tools originally designed to create homogenous study populations — as if they were meant for diagnosis. This misunderstanding has closed many physicians’ minds, leading to delayed diagnoses and unnecessary suffering for countless patients.

One of my mentors in Wisconsin used to say something so simple, yet so wise:
"If it looks like a duck, swims like a duck, and quacks like a duck, then it's probably a freaking duck."

Yet, somehow, many of us have forgotten this basic clinical intuition.

Just recently, I saw a patient with recurrent neurological symptoms and progressive disability. I told him, "I'm not a neurologist, but you strike me as a textbook case of MS (Multiple Sclerosis)." He nodded — and said that two neurologists had already told him the same.
But both refused to make the diagnosis.
Why?
Because he didn’t meet the criteria.

That is insane.

We see this all the time in rheumatology, too — patients suffering for years because they don't "fit the criteria," even when the clinical picture is obvious.

Let’s be clear: classification criteria were never meant for clinical diagnosis. They were developed to ensure consistent inclusion in research studies. Using them as diagnostic tools in practice leads to both under-diagnosis and over-diagnosis.

It’s time to stop the madness.
We must reclaim clinical reasoning, trust our judgment, and remember that patients don’t always read the criteria before they show up in our clinics.

We continue to see from time to time, significant kidney damage in some patients, due to "supplements" and "nutritional support" like "protein shakes", most likely due to tainting with melamine like in the infamous milk scandal that resulted in kidney injury in thousands of children, and even death in some.

STOP these "poisons".

2008 Chinese milk scandal - Wikipedia The 2008 Chinese milk scandal was a significant food safety incident in China. The scandal involved Sanlu Group's milk and infant formula along with other food materials and components being adulterated with the chemical melamine, which resulted in kidney stones and other kidney damage in infants. T...

One of the common problems we have in rheumatology is that a significant number of patients who have inflammatory arthritis will present with COMPLETELY normal blood tests and X-rays, and sometimes will ALWAYS have normal blood tests, so they are told “all labs and X-rays are normal so no disease exists” resulting in a long delay of the diagnosis, causing a lot of suffering for patients, and resulting many times in serious damage to their joints.

So the message is “Inflammatory arthritis CAN be present even with COMPLETELY normal blood tests and X-rays"