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Saturday, 30 November 2013

If You Consulted My Rheumatologist This Is What Might Happen

This is a description of what occurs at one of my typical visits to the rheumatologist, in case anyone wants to compare. At the initial visits there was more detail than described here, but after years there's a comfortable pattern.
Company while I wait for the doctor

At each visit, in addition to normal conversation, the Dr checks on my medications and asks if there are problems connected with them. Then he asks whether any new issues have come up since the last visit, good or bad.

In front of him are the forms I filled out in the waiting room. That gives him my assessment of pain and disease activity, and he sees how I rate my quality of life (HAQ) and ability to accomplish certain activities.

Then he checks for tender and swollen joints in my hands - the knuckles and the PIPs (Proximal Interphalangeal joints) - using the four fingered method of assessment. He marks this down on the homunculus he has stamped on his sheet of appointment notes. There's a space to record the total number of swollen and tender joints. I think he records morning stiffness as well. It is always asked.


Homunculus

On many visits he checks on the range of motion in my elbows and shoulders. It's no use any longer to check the range of the wrists since mine are damaged and one has been fused.

The next step is getting up on the "bed?". He checks my blood pressure and listens to my breathing with a stethoscope, front and back. Once I lie down on some visits he palpates my abdomen to determine if the liver is enlarged. At this point he checks lymph nodes too.
Next it's the lower body - internal and external rotation of hips and whether I can raise my legs, and a quick look at the knees and ankles.
Musculoskeletal exam

After this I sit down again and we discuss what happens next. I had a look at the chart and there's a space the doctor to record his impressions also. 

Then comes the plan. I complained once on Twitter that plans were often not communicated - that may be for the long term, but short term I leave knowing what should happen over the coming six months and with a new appointment date, bloodwork requisitions and any prescriptions needed.

Every year or two, if my ankle is painful he will give me a cortisone injection in that joint. For other joints (very infrequent) I have had ultrasound guided injections that needed to be scheduled through the hospital.

Sometimes he has a resident or fellow with him. This slows the process down but is often interesting. The last time I saw one he noticed something new, so even though it is sometimes repetitious for the patient it can be worthwhile. 

Though he covers a lot he is able to do it efficiently and carry on a conversation at the same time. It's very satisfying to hear expert opinions and to discuss health issues. 

3 comments:

  1. Thanks for sharing this, Annette - it's marvellous to read what a "real" rheumatologist does! I have experienced this with my retired rheumy - he was a hell of a lot faster on follow up appointments I suspect, but still very thorough.

    It was such a delight to see you recently. I'm sorry I have been awful in communicating... it's been a bit of a tough time... I did want to tell you how much I enjoyed that day and my only regret is that you live so far away! I would so love to be able to meet you face to face more often. You are a very dear person and I feel lucky to call you friend. <3

    Many blessings,
    Jane

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  2. I thought people might be interested. There is a wide variation in what people say about their appointments with rheumatologists, and I know mine is thorough. I always admire those with good people skills but for a doctor you hope the knowledge is there to back it up.

    I was terrific to meet you and Carmen in real life and you picked a good spot.for it. BC is so full of natural beauty. I hope we can do it again some day.

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    1. Hi hon, sorry I missed this - I seem to have lost the "subscribe to comments" feature again (brain fog) :(

      It was wonderful to meet you in RL - and yes, I definitely want to do it again! I'm just going to fire you an email! :)

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