Of late I have noticed a lot of negative comments being made in social media with regard to the helpfulness of doctors appointments, particularly Rheumatology appointments. This got me thinking, surely all experiences can't be negative, and the positive ones are just going unmentioned?

So in order to put some light on the subject I’m asking for your help. I have made a quick (anonymous) poll, so that we can see just how helpful, constructive, or otherwise, our appointments really are.

Go to http://endlesstrax.com/2012/02/21/poll-rheumatology-appointments/ to vote. All additional comments welcome.

Many Thanks

my appointments are now. that's largely because i really prepare.

i make sure my "medical resume" is up to date, print out a new copy, and hand it to the doctor when i get there.

i have a small spiral notepad (2x4 in) that i keep in my purse and take to every doctors appointment.

i keep all medical notes in that notepad, changing it out every year, so at the end of the year i have all my medical notes for that year in one place. i record the date, doctor's name, bp and weight at the top of each page. if its blood work or imaging, i keep track of that as well, with the date and what the tests were for specifically.

then on one page i list the comments and questions i have for the doctor.
and on the next page i write down everything the doctor tells me of significance.

i also go in with clear goals in mind and that goes on my comments/questions page.

then i'm receptive to what the doctor wants to accomplish and that goes on the other page as i take notes as he talks.

then at the end of the meeting, i summarize in a sentence or two what he wants me to try between then and our next visit.

in essence, my doctors' visits have become very much like any other meeting (i might have at work). and since i started approaching it like that, most of my visits are very productive. its only the doctors with whom i did not have good relationships with where the visits were less than productive.

a combination of reading the book, "how doctors think", and taking the best ideas from people here is what helped me become more efficient at the doctors.

Ditto on what Sue said. Go prepared! If you ask a question make sure it is answered to your satisfaction because that is what the doctor is being paid for.

Thank you all for your feedback.

Thank you sue22 for yours also, even if you have gone and just spoilt my next blog post by listing everything I had planned to say . Better think of something else to write now

If you haven't seen the latest results it's rather interesting so far. Plus more comments on the post.

It's interesting how the comments can often be a polar opposite of the results.

LOL, that's funny!

but its nice to know we were thinking the same things

no one will see what i wrote except for the people here, so i'd say just go on with the blog you were going to write! i think a whole other group of people will find that.

Thanks Ricky, and thanks Sue, you've given me a lot of things to include in my own notebook. I've just started it, and it's sloppy!

Currently my rheumy is not very... well she's truly lovely, but I don't feel as if she wants to discuss with me. Or anything really. I have an appointment with a highly recommended, later this year. Very excited!

Short answer - NO. Because he doesn't want to see me again, isn't offering me any treatment other than NSAIDs (that GP prescribes) and thinks its fine for me to just deal with his physiotherapist as the only "specialist" involved.

I'd like to think I could use Sue's "meeting" approach, but in reality there isn't enough time in the appointments I do get (GP, etc) to make that work either. If I started again with someone else, I think I'd want to be giving them a 100 page "briefing document" first!

that was me with the first few rheumatologists. so yes, it does matter that its a doctor that believes we have whatever problem they specialize in, and believes it needs to be treated (with more than just X if X is not working).



ah! that's where the "medical resume" comes in.

when i first started to write it all down, i had like a 10 page "summary" of my "story". it was great for me, but nobody else would have ever wanted to read that.

i got it down to just a few pages to send off to the NIH, but again, that wasn't really the best document either.

however, the medical resume has been incredibly useful. and really everything that is important for anyone to know is there (all medications i'm on, all i've tried with why i stopped them (either didn't work or the side effects), all my tendon and ligament pulls and tears with dates, misc symptoms (like the mouth and tongue sores, like the dry eyes, like the rashes, the gastritis and IBS), a table of blood work, a list of imaging with the dates, a list of my doctors, other "unrelated" health issues (i say unrelated cause it took me a long time and discovering spondy to realize that the GI and joint inflammation is directly connected).

the medical resume is especially great for someone like me who is so detail oriented. it forces us to get to the meat of it.

and a list of questions, bulleted points, again, makes us zero in.

at first, i wanted to tell the doctors everything, the whole story, and yes, we should tell the doctors all the symptoms as we are not trained to know what is and isn't important and is and isn't related, but that's different than every detail. like its important they know that my dq tendonitis was bad enough to need a cortisone shot and months of PT, but the rest of the story probably doesn't matter. or that i tore my bicep tendon pulling a cart (because who does that!) but the rest of the story doesn't matter. just enough of the details so they got the gist of how bad it was, nothing more.

i think too practice makes perfect (or at least better). i think for each rheumy I got better at explaining things.

but too, a good doctor can see through all the noise and zero in on the important aspects. that is a true gift though and so when i meet a doctor that can do that really well, i'm extremely impressed. but if someone can't, its our job to help them achieve that as much as we can as well. its a two way streets i think.

Oh dear, my inaugural post here is going to be a doozy, hahaha!

Hi all, I'm Julie, and I hate my rheumatologist! My first rheumatologist was incredible -- thorough, caring, pro-active. He was a certified naturopathic practitioner, along with being an M.D.! He was a believer in diet and supplements as an important part of treatment with modern medicine and new therapies. Silly me, I thought this was the norm!

And then I moved. The rheumatologist in my new city was lazy beyond belief. He worked three days -- Wednesday, Thursday and Friday. He was horrible about calling in medication refills. I learned that it took about 3 weeks of pharmacy faxes and phone calls to get him to respond so I had to plan accordingly. If you were having problems, his office told you to go to the ER; he would not fit you into the schedule no matter what. People were complaining to the hospital who recruited him and he left town.

So, I was referred to another one about 100 miles away. I figured that he couldn't possibly be any worse than the last one. Wrong! He is condescending, arrogant, and sarcastic. He asked me questions and would mock my answers or interrupt me if I didn't speak quickly enough. At the end of my first appointment, he decided to take me off all of my meds and see what happens. He told me I can't have inflammation because my labs looked pretty good. Um, so why were my ankles and fingers swollen? He didn't bother to examine me beyond looking at my hands and feet. And he didn't look at any of my previous medical records.

I will be calling his office first thing in the morning because I have been in excruciating pain all weekend. He needs to hear what's going on and own the poor decision he made. I can't even take a deep breath because my chest hurts so much. I'm walking hunched over because of the pain in my spine. I had to go to an urgent care clinic last week because of the pain and they scheduled some MRIs for me tomorrow.

I hate this rheumatologist but he's the only one in the area right now. I'm not well enough to drive to Dallas regularly to see another one.

The problem with me doing a medical resume right now is that I have absolutely no idea which bits are important and which aren't. It would be like doing a job resume when you have a really varied work and skills history, and don't have a clue what the job description you are going for is. It would be far too easy at the moment for me to either put in stuff that is completely irrelevant, or risk missing the really significant thing that might swing a diagnosis.

What I want is an old fashioned doctor who actually knows how to interview patients, follow up on significant things, and ask the right questions to get the additional info they need once they have their starting hypothesis. I should be able to just go into a doctor and say "my back hurts", and then have them follow some kind of questioning algorithm to not only get to the bottom of my back stuff, but to also draw out all the other potentially related stuff. I shouldn't have to second guess what info they might want or need from me.

while i agree with that second paragraph, my medical resume does have everything, but by it being bulleted words, its only a few pages. PM me your email address and i'll email you mine if you are interested. it could be helpful as i often think we have a lot in common (medically).

Oh, I would love an old fashioned doctor too C... Back when medicine was more an art than a business. Sigh...

Tea, wow poor Tea. That's horrible. I would be making a call to my old beloved rheumy, and relate exactly what has happened. See if he can recommend ANYONE in the area, GP, ortho, anyone that would work for you and with you, and maybe consult with him. I would definitely NOT put myself back in the hands of the jackass that took you off your meds!

Tea, perhaps it would help if you could get your GP to give you scrips for the meds that you need. I know my GP is good about things like that. He probably couldn't give you something like a TNF blocker because the insurance would make problems, but most everything else would be OK. Have a talk with him about all the problems that you are having with the Rheumy. Your GP needs to know how bad the Rheumy is so he won't refer other patients if he can avoid it.

had an experience yesterday with my GP (he replaced the old one that retired and since we had no better options, just went with the change) that reminded me, it really does take two.

i'm lucky i finally have a rheumatologist who is helping me because for the third (and last) time now, the GP called me in, then proceeded to not help me with anything. all i really wanted from him was a renewal of zanaflex. he cut my prescription in half to just one a day (instead of two so i can take it one a day and when i need it (travel, dentist, scans, flares, etc) because he doesn't really believe in people taking very many drugs. says muscle relaxants should only be for short term use. etc. i've been on a very low dose, only 2 mg at a time, usually only once a day, been monitoring my liver for the last 10+ years on it. when i asked him how i was supposed to manage, he told me to figure it out and just deal with it. how is that helpful? i asked him some other questions about exactly how i'm supposed to do that, and since he really couldn't answer it, and i wasn't taking "suck it up" for an answer, he told me to ask my rheumatologist for the med instead, as yet another thing he doesn't feel comfortable doing for me. i'm not sure what he feels comfortable doing, as he's turned down every request of mine, that the old GP used to do for me.

yes, time to change GPs.

but i did have bad dreams last night about not having the medication i needed and losing my job because i could not function.

i know i shouldn't let a doctor get to me that badly, but i work so hard at staying as well as i can, with the help of my rheumy, GI doc, etc, that i do get upset when instead of helping me, a doctor puts roadblocks in my way.

so, time to move on.

only problem is every time i get a recommendation to a GP that someone likes, (s)he isn't taking new patients.

but will ask the rheumy for a recommendation for someone with a comparable philosophy to his. so that we can all work together as a team. its very difficult when i have one group of doctors who believe in a holistic approach of needed meds, supplements and vitamins, basically whatever it takes to get the job done. and another set of doctors who think the first set are over prescribing me things. yesterday the GP said that i should be able to take care of all my health problems through a healthy diet and exercise. i told him i've been doing all of that since my 20s, and its not good enough. he then proceeded to tell me that he was from a third world country where they didn't take all these supplements and meds, and they did just fine. it was a weird conversation to be having.

some doctors are very hands on. some are very hands off. while in theory i like opposing views, since it forces me to think for myself, it gets kinda exhausting as well to feel like a human ping-pong ball.

good thing i was feeling so well being on the prednisone this week, or the appointment would probably have upset me more.

my husband has already changed GPs, though not sure the new one will be good for me. he moved on when this GP told him that maybe his fatigue was "all in his head" and then laughed.

i hate to see my good doctors retire. its like any relationship. we hate to see good ones end.

Thank you, Kancie. I have an appointment with him scheduled for Tuesday. It will be my last one. I was going to blow him off entirely but I decided that I need to go and tell him point-blank how badly his decisions affected me. Maybe it will make him think twice before doing that to someone else.

I called his office on Monday to report how poorly I was doing and his nurse never returned the call. Big surprise, lol. They don't want to deal with it. When I was filling out the paperwork before my first appointment with this doc, I thought it was strange that one of the questions asked if you'd ever filed a lawsuit against someone in the medical community. Perhaps I now know why he asked that question -- he's incompetent!

My nurse manager from my insurance company said the hospital is really looking to bring a new rheum. in ASAP. It will probably be a good one since the last one they hired was pretty bad!

Donna,
Oddly enough, this bad rheumy wrote me new prescriptions for my meds with a bunch of refills -- and then he told me to stop taking them. LOL, that's about how much sense this joker made! At least I have an ample supply of meds, though. I take Cellcept and Plaquenil.

My GP is wonderful and she has been managing my care and writing prescriptions for me in the interim. However, I've been doing badly and she hasn't felt qualified to intervene in the autoimmune stuff. I see her next week and she'll be getting a full report on the bad rheum., lol.

Who, besides a rheum., can manage AS? Would an orthopedist work? We have several good ones here.

My doctor never called in the medical information. January 24 and now he has waited so long that the insurance company has canceled the claim.
I decided to not worry, I have already lost everything else. the truck? come and get it.....
meds? nope...cancelled. rehabilitation doctor appointment....cancelled. paying bills.....cancelled.
At least he didn't charge me this week for the appointment. He seems clueless about the guidelines that my employer has. I am sure things will work out one way or another.
I have become quite good at being broke, with no income for months at a time.
thanks doc, hope you had fun on your two weeks vacation.

I am very lucky that I had my good rheum. when I filed for SSD. He kept meticulous records and was so thorough. If I had to be diagnosed and first seen by one of these last two losers, I'd be dead by now. I'm not being overly dramatic. I hope you can get a better doctor and the help you deserve!

I do think I have a good doctor, I really would not trade him in. He is also a good person. I am just sick, and broke...and sick of being broke. Denied, appeal, get paid. I called the insurance company today, he has at least called. They want him to fax more stuff.
In the meantime while the insurance and doctor play tag, my health gets worse, I just don't do well with termination letters from my employer.