What Kind of Relationship Do You Have With Your Rheumatologist?
I’ve been so very fortunate with specialists. When my primary care physician (PCP) recommended that I see a neurologist, I took an appointment with the first available doctor. I lucked out and became a patient at one of the larger MS clinics in Northern Virginia.
When a hand surgeon suggested that I needed a rheumatologist, he made a specific recommendation for a doctor whose office was less than five miles from my house. This rheumatologist is the one who initially diagnosed me and worked with me to find a treatment regimen that works well.
Our appointments were very predictable. The nurse took my vitals, pulled up my records on the computer, gave me a RAPID 3 (Routine Assessment of Patient Index Data) form to complete. I would fill out the RAPID 3 form which helps to establish the patient’s assessment of disease severity. My rheumatologist is the person who would conduct all interviews and examinations.
While we spoke, my doctor would methodically check my joints. Not only did she examine the 28 joints included in the DAS28 (Disease Activity Score) —10 joints in each hand/fingers and both wrists, elbows, shoulders, and knees—she also checked my feet/toes, ankles, hips, and head/jaw. She palpated my abdomen and listened to my heart, lungs, and gut.
When the exam moved along smoothly without too many swollen or tender joints, she found time to talk about exercise, diet, weight, and emotional health. I never felt rushed and I always felt well cared for. I had little doubt that something would go unnoticed. I also always left with a hard copy of her quick exam notes and laboratory orders for blood work to be completed every three months.
There was one time that my doctor touched a spot on my left ankle that elicited a quick “ouch, where did you just touch?” in the middle of our conversation. I had been stiff, but I wasn’t aware that I actually had a seriously swollen and tender spot. Although the ankle is not included in the 28 official joints to be checked, she always included it in her exam.
Fast forward to my new rheumatologist who admittedly I chose because I wanted someone who would be willing to continue my chosen treatment without much fuss. Now I realize that’s exactly what I have—a doctor who will willingly write the prescriptions I need for RA meds.
So is there a problem? I’ve seen my new rheumatologist for three visits. The nurse (not always the same nurse in this larger office) takes my vitals and hands me the RAPID 3 form. The nurse will also ask me questions about how I’m doing. Any complaints or problems? Anything to let the doctor know?
It seems like the rheumatologist reads the notes rather than asking me questions that might reveal prompt more information about how I’m really doing. When she conducts her exam, she hardly touches all of the relevant joints. She certainly doesn’t bend my wrists back and forth and side to side, or squeeze my knuckles firmly enough to detect swelling or tenderness that I might not have been paying close attention to. She definitely hasn’t played with my toes or squeezed my ankles, or put my hips through their full range of motion.
As you may be able to detect from my tone of voice, I’m not so sure that I’m getting the care that I deserve. Admittedly I’ve been doing well for quite some time and any flares that I’ve had in recent years were mild, except for the case of episcleritis that took 9 weeks to resolve rather than 7-10 days.
I’m definitely not getting the kind of care that I would want every other person with RA to receive. But maybe my new doctor would conduct our visit differently if I had greater needs. I am just concerned that something might go unnoticed if I fail to make my own assessment before seeing her.
So my questions to the community are these:
- What type of relationship do you have/want with your rheumatologist?
- Does your doctor conduct a full examination regardless of what might be going on?
- How would you want your relationship with your doctor or the visit to be any different?