You and your doctor

Developing a partnership

This article is about a special kind of relationship--the one between you and your doctor. If you have arthritis, you know just how important this relationship is. We hope this information helps you to make it one that is valuable and rewarding.

Since arthritis care often requires frequent visits to the doctor, an ongoing partnership can develop if you and your doctor are willing to work at it. It's to your advantage to have the best possible relationship with your doctor, because by helping your doctor, you help yourself.

A partnership in arthritis care is a relationship in which:

• The person with arthritis actively tries to understand and learn about his or her medical condition and treatment program. The person also makes a commitment to follow the doctor's advice.
• The doctor tries to be aware of the person's needs, doing such things as making an effort to explain difficult concepts fully.
• The person with arthritis and the doctor discuss the effects of arthritis and the treatment program in an atmosphere of respect and trust.

It takes effort and time to develop a strong, working relationship. You'll realize, though, that your efforts will help you to better control and manage your arthritis.

You can help your doctor help you by doing the following:

• Making a commitment to take an active role in your medical care
• Choosing to follow your treatment program as best you can
• Getting the most out of office visits
• Talking honestly with your doctor

Doctors are human beings too

To be more at ease with both your doctor and other health care professionals, try to realize that they are human beings, too.

Doctors aren't superhuman

Like you, doctors are subject to moods, pressures, and mistakes. There is no reason to be in awe of your doctor, nor is there any need to blindly follow orders without asking questions.

If you tend to hold your doctor in awe, as many people do, you may not want to "bother" him or her with questions. If you feel this way, try to remember that your doctor's job is to provide you with good medical care. Therefore, you have the right to receive certain services from your doctor.

Doctors aren't mind readers or magicians

Most of the information doctors use to diagnose and treat you must come from you. Therefore, your doctor needs to hear your ideas and observations. It's in your best interest to be specific about how you feel and what you think.

Also, if your doctor explains something to you, and you don't understand it, he or she won't know that unless you say so. You might tell the doctor: "I still don't understand. Can you explain it again?" Don't feel stupid if you have to ask the same question again. Part of a doctor's job is to be an "educator," and this often means going over the same point several times.

Doctors aren't instant healers

Most forms of arthritis can't be cured, though they can be controlled. However, no one type of medication or other treatment works for everyone. You and your doctor may have to go through a period of "trial and error" to find out what works best for you. Even then your treatment program may continue to change as you change.

Health care professionals

Many health professionals may be involved in your care, depending on your condition and whether they are available in your area. Some of the health care professionals you might meet are listed below. The first eight are medical doctors, and the next seven are arthritis health professionals.

• Family physicians and general practitioners provide general medical care for adults and for children.
• Internists provide evaluation and management for adult diseases.
• Rheumatologists specialize in treating people with arthritis or any of the rheumatic diseases.
• Orthopedists help evaluate and manage bone and joint problems and can perform surgical procedures such as joint replacement.
• Physiatrists are physicians who may direct your physical therapy and rehabilitation.
• Ophthalmologists are physicians who may provide eye care and treatment.
• Pediatricians are physicians who treat childhood diseases.
• Psychiatrists are physicians who may provide treatment if you have mental or emotional problems that need special attention.
• Podiatrists are experts in the care of feet. If your arthritis affects your feet, podiatrists can prescribe special supports and shoes to help you.
• Nurses trained in arthritis care assist your doctor with your treatment. They also help explain your prescribed treatment program and can answer many of your questions.
• Physical therapists may show you exercises to maintain muscle strength and use of joints.
• Occupational therapists may teach you how to reduce strain on your joints while carrying out everyday activities. They may provide you with splints and other devices to help protect your joints.
• Psychologists help to solve emotional or mental problems.
• Social workers can help you find solutions to the financial and social problems you may encounter.
• Pharmacists will fill your prescriptions for medications and can explain the actions and side effects of these drugs. They also advise you about drug interactions and over-the-counter medications.

You are in charge

What to expect

In order to have a partnership with your doctor and other health care professionals, you should expect good medical care from them. Good medical care includes being told about your arthritis and the essential facts of your treatment. This information should include costs, medications, side effects, and other possible options for treatment.

In addition, you should be assured of privacy concerning your records, hospital stays, and finances. If you ask for a second opinion, your doctor should assist you by suggesting other physicians you can consult, and by making your medical records available to the person you select.

Every member of your health care team should contribute to your good medical care. If you don't feel that you're getting the right attention from one of the members, let that person and your doctor know how you feel. Remember, team members aren't mind readers. It is your responsibility to inform them of your concerns. Otherwise, they will probably assume that you are satisfied with the care you are getting.

It is important for you to understand that if you criticize a member of your medical team in a positive way, it does not hurt his or her feelings. Your comments won't be taken personally and you will probably be thanked for helping to improve your care. By letting the team members know your feelings, you can help foster the cooperative spirit that is necessary for the success of the whole team.

Preparing for a visit

To get the most out of office visits, it's helpful to prepare before each appointment. Doctors appreciate your preparation because it makes their jobs easier.

Before your visit, try to keep in mind:

• the time spent with your doctor may be brief
• you must make the most of that time
• if you waste time or don't ask questions, you won't get the information you need to make the best decisions about your health, and you may not get the best return for your money

Remember, it takes time for your doctor to answer your questions. If you have many, consider scheduling a longer appointment. Don't forget your doctor has other patients.

As you write down your questions, also prepare a brief but accurate progress report. Your doctor will most likely ask: "Have you been following your treatment plan? How have you been feeling? Have you had any problems? What has been happening in your life?" You might find it helpful to jot down the answers to these kinds of questions ahead of time.

Be ready to report the names and the dosages of the drugs you're taking. If you're taking several medications, you should bring in your pill bottles (if you're visiting a physician other than your regular doctor, it's especially important to bring all your medications with you). If you don't already use a "drug usage" chart, your next office visit may be a good time to discuss one with your doctor. The chart lists all of the drugs you take, any special instructions, and when you should take them. To show that you took your medication, simply put a check in the space provided. This way you keep a permanent drug record for yourself and your doctor. If you are seeing your doctor on a return visit, make a list of any refills of medicines you need.

During the visit

• Answer your doctor's questions, and report your progress.


• Be honest. If you haven't been feeling well, or if you are frustrated with your treatment, tell the doctor.


• Be concrete. If you have pain, try to describe how intense it is on a scale of one to ten, with ten being the worst. Try to be specific about which part of your body is bothering you.


• Also explain how your pain or limitation of motion prevents you from doing certain activities that are important to you. These might include driving your car or brushing your teeth.


• Tell the doctor about any fears or complaints you have about your treatment. Your doctor can sometimes reduce your fears by explaining the treatment in greater detail. Or if you have a problem with your treatment program, perhaps it can be changed slightly. Listen to what your doctor tells you. If, after giving it careful thought, you disagree with your doctor's advice, talk it out. There may be other treatments you can try, or the doctor may be able to explain in a better way why you should follow a certain program.


• Report any unusual symptoms you have noticed. Drugs used for the treatment of arthritis can have side effects, so it's important to tell your doctor about any unusual symptoms or bodily changes you have noticed. Typical changes may include a skin rash, sores in the mouth, dizziness, or changes in the color of your urine.


• Remind the doctor of what you want your interests and needs. Your treatment program should be a combination of medications, therapies, and exercises that are suited to you. Remembering your interests and needs helps the doctor develop the best program for you. For example, he or she may be able to help you keep the pain m your knee under control so that you can continue to play golf. Or if you tell your doctor that you find it difficult to take medication four times a day, he or she may be able to prescribe a drug that you take only twice a day.


• Share with your doctor important events in your personal and social life. Events in your life can affect your arthritis and they can also affect the way you take care of yourself. For example, your doctor needs to know if your rheumatoid arthritis tends to flare up after you and your husband fight. He or she also needs to know if you get depressed during the holiday season and forget to take your medication. Learn to share this information and talk honestly about your emotions.


• Ask for an explanation. Always ask your doctor to explain anything about your arthritis or your treatment program that you don't understand. Try repeating what you think you heard. It's a good way to make certain you really understand. For example, you might ask "In rheumatoid arthritis, the lining of the joints gets inflamed somehow and that causes fluid to build up inside it?" If you've got it wrong, your doctor can correct you. Sometimes it's helpful to bring in a friend or relative when you see your doctor so you can discuss what the doctor told you.


• If your physician adjusts your treatment program and you don't know why, find out. Also ask about possible side effects and what you should do if they occur. Remember, the more you know about your arthritis and your treatment, the more you can help the doctor help you.


• Keep in mind that talking honestly means giving and taking in an atmosphere of respect and trust. However, you should try to be "selective" when you tell the doctor about your complaints. If you always bring a large list of complaints, your doctor may stop listening attentively and could ignore something new that is truly important.

Following your treatment program

Part of developing a partnership with your doctor means trying your best to follow the treatment program. All too often, people fail to follow their doctors' instructions for one reason or another. Perhaps they forget, or they get too busy. Make working for your good health a routine. For example, place your drug usage chart on your mirror or refrigerator or bathroom door to remind you to take your medications. Make a habit of doing your exercises at the same time in the same place every day. Your doctor or other members of your health care team may be able to provide other suggestions to help you follow your treatment program.

• Make notes. After you have visited with the doctor, go to the waiting room to make notes, or write your notes at home. If medication instructions aren't clear to you, ask for an explanation from the nurse before leaving the office.


• Don't change your treatment program on your own without good reason. This is very important! If you have a problem with the treatment, consult your doctor. Many people stop taking their medications once they start feeling better. Or if they don't start to feel better right away, they give up. Either way is wrong. In arthritis treatment, you have to understand that the drugs may take time to work. Some drugs can take months before a noticeable change will occur. However, if you improve right away, that doesn't mean you should stop taking your medication. Feeling better doesn't mean that you've been cured. It just means the treatment program is working.


• Also, don't follow other "medical" advice without first checking with your own physician. You may watch a TV show or read a newspaper article about a new "miracle cure" for arthritis. Be cautious of any claims about cures. If you're curious and feel tempted to try one, call your doctor for an opinion, or ask at your next office visit.


• Stay alert for side effects. Observe your body and judge how you feel. If side effects occur, refer to the notes you took at your office visit and see what you should do. If you aren't sure, call your doctor.

Each time you have an office visit, you and your doctor have an opportunity to further develop your relationship. Discussion is a necessary part of good medical care.

Your financial needs

Second opinions

If you are unsure of some part of your diagnosis or treatment, you can seek a second opinion from another physician. Ask your doctor to recommend a consulting physician. Sign a release form and request that a copy of your medical records be sent to the consulting physician.

Your doctor has nothing to lose and usually much to gain by helping you find a second opinion. Your diagnosis and treatment should be based on sound principles. Another opinion should only confirm this.

Usually the consultant will call or write a letter to your doctor, stating findings and giving advice for treatment. Discuss the consultant's advice with your own physician, and decide if the second opinion should make any difference in your treatment plan.

Your changing treatment program

Credits

Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK, contact the National Helpline: (800) 283-7800.

Adapted from a pamphlet originally prepared for the Arthritis Foundation. This material is protected by copyright.