What should a person expect at their first appointment with a rheumatologist? Prior to the appoinment, there’s quite a bit of paperwork – that’s covered in part 1. Both of my the rheumatologists mailed the paperwork to me to complete beforehand, with the promise that my exam would be cancelled if I arrived without the paperwork. Fair warning – that paperwork is important.
Arriving half an hour before your scheduled appointment is frustrating. The doctor really isn’t keeping you waiting, though. First all your paperwork is placed into your new chart (or, I suppose, rushed through data entry if the office is computerized). Then the doctor takes time to review your information before meeting you. Finally, then, it’s time for the exam.
When you’re taken to the exam room, the doctor should review the paperwork with you, clarifying and confirming the information you provided. Based on that info, the doctor will have ideas about your possible diagnosis. He’ll ask you to clarify anything that’s not clear and likely scribble little notes all over your paperwork. Then he will examine the body parts that you’ve indicated are a problem.
Your referring doctor should have sent a copy of recent lab results, and the rheumatologist will review them. Most likely you’ll have your blood drawn again, and the RD will order additional tests. It’s probably a good idea to ask the technologist who draws your blood to please send you a copy of the results (you’ll need to sign a release). If your eventual diagnosis results in an ongoing relationship with the rheumy, you’ll be getting lots of bloodwork, and it might be nice to have your own file/notebook with all the reports.
At your initial appointment, you’ll probably have x-rays taken (many rheumatologists employ an x-ray tech and have a machine in the office). X-rays will show if structural damage has already occurred, and these pictures will be used as a base-line to determine whether future treatments are effective (the goal is no new damage).
X-rays don’t show inflammation; they only reveal whether damage has already occurred. MRI is more effective than x-ray in showing what’s currently going on, however this technology is expensive and many insurance companies won’t cover it. It’s probably not a good idea to introduce yourself to a new doctor as someone who’s going to be a demanding PITA. Just go along with whatever tests the doctor orders – at least this first time – unless there’s a compelling reason to do differently.
Once the exam is complete, your doctor should have an idea of what your diagnosis is. However, that is not always the case. Sometimes the rheumatologist can tell that there’s something autoimmune happening, but be unable to distinguish exactly which disease you’re dealing with. Since many types of arthritis have identical treatment plans, an exact diagnosis isn’t always necessary. We WANT to know what’s wrong, but it’s more important to begin treatment. Given time, the right diagnosis will appear. Trust your doctor, and work with him.
More information about what to expect at this initial appointment can be found in a thread pinned to the top of the Arthritis Foundation’s RA Connect forum.