When You’re Referred to a Rheumatologist

 

Nobody wants to need a rheumatologist, but if you have to go, go prepared.

1. Get copies of all recent lab work from your doctor(s).  Your rheumatologist will want this information.
2. If you have recent joint x-rays (CT, MRI, etc), get a copy of the radiologist’s report.  The rheumatologist will definitely want the report (and might want the x-ray films/digital file, too).
3. Compile a complete medical history.  Take the time to contact your parents, grandparents, and siblings for information.  If there is a family history of significant diseases, you might consider contacting aunts, uncles, and cousins, too.
4. Think about your symptoms.  The doctor will need this information, but you will forget to mention something pertinent if you haven’t taken the time to know what you’ll say.  Keep it short and to the point.  Things to think about (based on what I’ve been asked and other patients say they’ve been asked):  What hurts?  When did it start?  What were you doing?  Is it worse in the morning or evening?  Does activity make it better or worse?  What treatments have you tried?  Did they help?  Does anything make it better/worse?

When you phone the rheumatologist’s office to make your appointment:

1. Ask them to mail the paperwork to you.  This will allow you ample time to fill out all the forms.  I’ve previously written about the paperwork.
2. Ask them what you need to bring with you to the appointment.  Do they want your x-ray films (if applicable)?
3. If there will be a significant amount of time until the doctor has any new-patient appointments, ask if they have a waiting list and can call you if there’s a cancellation.

Before your appointment:

1. Carefully complete the doctor’s paperwork.  (If you have better penmanship than I do, you can do this by hand; if your handwriting looks anything like mine, you can scan the doctor’s forms into your computer and type the answers.  Receptionists love this (my doctors have never commented, but they’ve also never overlooked information due to a lack of legibility)).
2. Find a babysitter.  Do not take children with you to this first appointment.
3. Juggle your schedule for the day of the appointment.  An initial appointment will take a minimum of one hour – maybe as much as four hours, depending on the doctor.  Make sure you allow enough time in your schedule.
4. Find out if your insurance plan requires pre-approval for MRI (the doctor might ask).
5. For the initial appointment, no make-up or nail polish (don’t buff your nails, either).
6. Consider skipping food.  Some blood work might need to be done fasting, so it’s easiest to just wait until after your appointment to grab a bite to eat.
7. Dress in shirt/shoes that are easy to remove.  You will need to undress for your exam; make it easy on yourself.

The initial appointment:

1. You’ll need to arrive early so that all the new-patient registration junk can take place.  Have something to keep yourself occupied while the receptionist is processing your paperwork.
2. Don’t forget your insurance card and picture identification.
3. Give your lab work, x-rays (if any), reports, etc. to the receptionist.  Don’t make the doctor ask for it.
4. Your doctor will go over all of your paperwork.
5. You will have a physical exam.  Pray that the doctor does not bash in your knees with a reflex-hammer.
6. If your doctor does a tender-points test, say NO, none of it hurts.*
7. Your doctor will order blood work.  Ask to have a copy of the results sent to you.
8. Your doctor will order x-rays or MRI.  Some doctors do this on-site.  It doesn’t matter where they’re done.  The point is that the doctor needs to see if there’s any visible damage to your joints.  This will serve as a baseline; the tests will be repeated every couple years or so (depending on the doctor).

Allow time to go to the pharmacy when you are done with the doctor, lab work, and x-rays.  It’s pretty common to have a prescription for an anti-inflamatory (either prednisone or an NSAID), and one or two DMARDs (methotrexate, plaquenil, etc.) (and maybe a pain medication just until things are under control).  The goal is to hit RA fast and hard (early, aggressive treatment).  Once the disease is under control, it might be possible to scale back on the meds, but for now do whatever it takes to stop RA in its tracks.

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*Kidding.  Sort of.  If you’re in excruciating pain, then by all means be honest with your doctor.  Be aware, though, that the tender-points test is for fibromyalgia, a diagnosis which will forever label you as a psych case to a large portion of the medical profession.