Rheumatologists treat well over 100 different types of diseases.  These diseases are complex and affect many organ systems.  Diagnosing a rheumatic disease is like solving a complex puzzle.  Every first consultation includes a detailed history, a physical examination, and a review of past blood work, x-rays, and documentation from your other doctors.  All these help your rheumatologist solve the puzzle.

Preparing for a rheumatology consultation is a bit like preparing for a meeting with your accountant.  You want everything organized in advance: W-2, investment income statements, IRA/pensions distributions, child care costs, etc.  You want everything neatly laid out in advance, so that your consultation is as productive as possible.

Laying the groundwork

Make sure your rheumatologist has all the information at his or her disposal well before your appointment.

• The progress note from your referring physician. What is the question that’s being asked?
• Your primary care physician’s (PCP) last progress note.
• The results of any blood tests.
• The results of any x-rays or any other imaging.
• If you had a biopsy that relates to your symptoms (e.g., skin biopsy, kidney biopsy, lung biopsy), your rheumatologist will want to see the pathologist’s interpretation.
• If you are transferring care from another rheumatologist, your current rheumatologist will definitely want to see that information.

Bring an updated list of your medications and allergies

It’s always a good idea to have a written updated list of all your medications and allergies.  Make sure you bring this along to your first consultation.  Do not assume that your PCP’s updated medication list is up-to-date. Some people see more than one doctor and they’re all making changes independently.

Anticipate questions your doctor may ask

Rheumatologists certainly have access to high specialized blood tests and imaging, but the medical history is by far the most important part of the consultation.  Before your visit, try to expect some questions your doctor may ask and then write them down.  Here are a few that may help you get started.

• When did you first notice something was wrong or had changed?
• Describe your symptoms.
• Has this ever happened before? If so when?
• Do the symptoms come and go or are they continuous?
• Is there a particular time of day where they are worse?
• What makes your symptoms worse? What makes them better?
• Have you taken any over-the-counter medications for your symptoms? If so, which ones and did they help?
• Do you think you have other symptoms besides joint or muscle pain that seem connected?
• Have your symptoms caused you to make changes to your daily routine?

Anticipate questions you may have for your doctor

• Based on what you know, what could be causing my symptoms?
• What tests do I need to have done to help decide what my diagnosis is?
• Are there any symptoms that I should be looking out for?
• What kind of interventions could I do now, to help ease some of my symptoms?
• What kind of activities should I avoid at this time? (e.g, get pregnant, run a marathon, prolonged travel, etc.)

Actively listen and participate

You may feel overwhelmed when your doctor is giving you a new diagnosis, let alone giving you a complex set of recommendations.  You’re not alone.  A study looked at how much information (when prescribing a new medication) patients retained after their doctor’s appointment.  They found that only 64% of people were able to recall all the information that they discussed during the visit[1].  Not bad, but not great.

We know that recall of information improves health outcomes in people suffering from chronic diseases like rheumatoid arthritis and lupus.  Another study looked at aspects of doctor-patient communication that lead to higher recall.  They found that active patient engagement and explicit conversations about medications improved recall.[2]  Here are a few tips about becoming a better active listener.

• Pay attention
• Show that you’re listening
• Provide feedback
• Defer judgement
• Be candid, open, and honest in your response.

You may also want to write things down in a journal (highly recommended) or maybe you may want to bring an advocate to your consultation.  This could be a trusted friend or family member.

Conclusion

Being ready for your appointment, active listening, and asking questions to understand your symptoms is central to not only making the most of your rheumatology consultation but also, becoming an empowered patient.

Please follow this link to request a rheumatology consultation.

[1] Tarn DM, Flocke SA, New prescriptions: How well do patients remember important information? Fam Med. 2011 Apr; 43(4): 254–259.

[2] Richard C, Glaser E, Lussier MT. Communication and patient participation influencing patient recall of treatment discussions. Health Expect. 2017 Aug; 20(4): 760–770.