What's up Doc?

Among the many ongoing decisions associated with wisely managing Rheumatoid Arthritis, arguably the most crucial one is who to turn to for treatment.  First you must decide which medical professional you want to work with.  The choices are many:

1) A Rheumatologist - a trained specialist in the field of joint disease.

2) Your Primary Care Physician - the one you go to for most of your medical needs and who may know your overall health profile best.

3) A PA or Physician's Assistant - often works with a PCP but may be easier to get in to see without much notice.

4) Other assorted professionals such as Orthopedists, Surgeons, Nurse Practitioners, Acupuncturists, Physical and Occupational Therapists, etc.

Many of us do a combination of professionals comprising what I like to call my "medical care team".   I turn to different professionals depending on my medical needs at any given time.  For instance when I had my feet rebuilt I clearly needed to work with an orthopedic surgeon and then a physical therapist as well as my rheumatologist and PCP.  Often it is the combination that ensures the best outcome.

So, how do you sort through all of the choices?  First of all, reflect on your own needs and factors that are important to you personally. For instance is it crucial for you to have someone local as opposed to having to drive a distance to be treated?  That may immediately narrow the choices.

There are a number of factors I considered when making my initial choices, not all obvious but still critical.  One thing I wanted to know was the doctor's experience in treating RA.  What are his/her credentials? For me that meant finding a specialist, i.e., a Rheumatologist, I could trust and work with.  Because I have complete faith in my PCP (Primary Care Physician), I asked for his recommendation and he suggested the doctor I am still seeing 20 years later!  When I was first diagnosed, I actually saw two Rheumatologists for a brief time before I settled on the one I see regularly now.  I found them both to be great but one was much closer (in fact is in my town) and since they both agreed on my treatment protocols I felt comfortable settling in with the local Rheumatologist.  I realize today what a luxury that was for me!

Don't stop at credentials. Another aspect to consider is the medical professional's staff and office dynamic.  That may sound strange, but for me the nurses and office staff are the "first line" and have a huge influence on my entire treatment experience.  I knew from past experience (some less than satisfying) that my connection and rapport with the office personnel was paramount.  You want to have folks who answer the phone with kindness, respond promptly to questions, get back to you without repeated contacts, fight (at times) on your behalf with insurance companies, process paperwork that you need such as testing orders, etc., know who you are, are sensitive to your schedule when planning appointments, etc.  One thing to watch is how they interact with the doctor.  The staff at all of the medical professionals I go to seem to have a solid, professional and respectful relationship with one another.  That speaks volumes to me. In turn, I treat them with respect.  I ask for appointments without being demanding.  I do not linger on the phone, knowing and respecting how busy they are.  I also get to know them by name and even drop off a thank you gift now and then - some homemade bread or flowers to just say thanks for all you do for me.

Another consideration is your own style of interacting with medical folks.  This includes what you want in a "bedside manner".  Some people prefer a "get right to the point" type versus someone who will spend a little extra time explaining things and reviewing options.  Also, do you want someone who definitively tells you what to do medically or suggests options and either you decide or you decide together.  Again this is a matter of preference.  I seem to do much better with the "partner" type style where we chew on options and then arrive at a consensus.

How easy is it to get in to see your medical team members?  This is huge for me.  I need to know that if I call any of my team with a critical need they will see me promptly.  That said, I am careful to not demand an appointment unless I am REALLY in need of it.  Otherwise I carefully and regularly schedule visits to stay on the right path.  Of course, during the early stages of RA, when fear, pain and lack of disease control were at their peak, I requested to be seen much more often than I do now.  My doctor's positive response to that was a key reason I stayed with him!  As we move through chronic disease management we learn how to navigate this aspect just as we do other components of RA treatment.

How much am I willing to do myself with regard to my treatment?  I needed to know as much as I could find out about the disease of RA before I even went for my first doctor's appointment with my Rheumatologist.  I had a list of questions and to this day I bring a list with me to every appointment!  He respects that because it shows I am invested in what is being done and it sends a clear message that I intend to have a voice in the choices being made.

Do not rely on other people's opinions.  I say this because there are times over the course of your journey that this will come up.  I am not suggesting that you ignore other's opinions but you absolutely must think for yourself.  For example, just within our own local RA Support Group there are very mixed feelings about my Rheumatologist.  For me, he walks on water.  For some others, they think he is adequate at best.  Still others do not find him the right choice for them.  For this exact reason you owe it to yourself to check out the options and potentially see a few professionals before you finally settle on your team.  The rapport and relationship you have with your "medical care team" can be the difference in successfully managing RA or being miserable and feeling you are not being properly cared for.

So what does all of this mean?  This is by no means an exhaustive list of all the considerations you need to work on but the critical decisions involved in assembling your "medical care team" are many and need careful attention if you are going to successfully manage RA.  It can and should be done with the same consideration you would give to any life-changing decision.  This is yet another key step in the treatment process and by factoring them into your choices you will have a true sense of control that will prepare you for the other decisions you will need to make to successfully manage RA.