What Do You Look For In A Rheumatologist?

The other day, I quickly skimmed an article (I can’t remember where) which has as it’s basic premise the theory that rheumatologists needed to show more empathy towards their patients. I’m not sure if I’m in agreement with such a statement, primarily because I don’t really know what this statement actually means, in practice.

Wikipedia tells me that empathy is “the capacity to recognize and, to some extent, share feelings (such as sadness or happiness) that are being experienced by another sapient or semi-sapient being.” Okay, so I know what this definition means, and I’m certainly not advocating for a lack of compassion in the medical world, or in any other professional relationship for that matter. But this is exactly what I consider my relationship with my rheumatologist to be: a professional relationship. And as with all of the many professional relationships that I maintain on a regular basis, the degree and the nature of any personal connection varies drastically, but usually is somewhere on the low end. (Otherwise, of course, I would call it a personal relationship.)

I often hear people complaining about the fact that their rheumatologists do not validate their pain. With this I can relate, because for years, I used to say as much. I’ve written before the finding a good rheumatologist is a lot like dating…the more expectations there are going in, the harder it is to find that perfect “mate.” After a couple of unsuccessful doctor-patient relationships, I finally asked myself exactly what it was that I was looking for from a rheumatologist. Thoughts of validation continued to hover in my mind. But as I continued to think about what this actually meant, I wondered of this was really what I was looking for. My answer was: no.

Now, I certainly need a doctor to accept the fact that I live with an autoimmune illness, even though I continually have the squeakiest-clean lab reports. If I ever encounter a doctor who tells me that there is nothing wrong with me (as I have on various occasions), right then and there I know that this isn’t the doctor for me…and move on to another one.

But once I’m working with a rheumatologist who accepts my diagnosis, what am I looking for then? Empathy? Validation? Not really. What I’m looking for (and don’t get me wrong, I’m not a cold-hearted person at all, it just goes back to how I approach professional relationships) is someone who can perform physical examinations and minor procedures, prescribe and monitor pharmaceutical treatments, and accurately interpret my lab reports.

And this, in a nutshell, is what I look for in a rheumatologist.

Anything extra is exactly that: extra. And just like dating, as soon as I lowered my expectations, I found a wonderful rheumatologist who I have been working with for the past couple of years. Yes, we have a relationship that goes beyond the three items that I listed above…there is a lot of humor, teaching (in both directions), and respect. In the past, when just nothing seemed to work, I often saw the pain and anguish in his face, the disappointment he felt with not being able to do more. Was this empathy or validation? To some people, it might have been. To me, it was a sign of a doctor who obviously wanted to do his best to treat his patients with the tools that he had; more importantly, it was a sign of professionalism.

I’ll add one more item to my list of what I look for in a rheumatologist, which I previously failed to mention because even if it’s something that my doctor does not practice, it’s something that I practice myself. And as an example, I’ll use my current rheumatologist: every option, every medicine, every procedure that is offered to me is presented as a question, as in “We could do x to you knee, do you want to do this?” or “You could take y medicine, do you want to take that?”

And then, it’s up to me to make my decision, and answer his questions. And whatever my answers might be, they are always accepted without judgment. Case in point: once, he offered to drain excess fluid from my swollen knee. I knew this procedure would provide some relief, but on that particular day I just knew that I didn’t have the strength to have a needle inserted into my knee. So I took a pass. This was okay with him, and it was okay with me.

Yes, we have the right to expect professional, kind service from our rheumatologists, and shouldn’t settle for anything less. But our doctors are only human, and have been trained in certain specialties. Rheumatologists should be aware of the psychological impact of the diseases that they treat, and should make the appropriate referrals when they see that a person is struggling with depression or suicidal thoughts…but the professionals who are best suited to deal with these issues are psychologists.

And when I myself needed this emotional and psychological support a few years ago, I did myself a favor and found a psychologist to work with. It was at this exact moment in time when I found a rheumatologist who provided everything I was looking for. A major factor of this success what setting appropriate, and realistic, expectations for each one of my relationships with various healthcare professionals.

Stay tuned…for the next adventure of Rheumatoid Arthritis Guy!

12 Comments
12 comments
  1. Wayney says:

    My rheumatologist sounds much like yours. He doesn’t hold my hand and “poor baby” me through anything. He gives me respect in that he knows I’ve lived with this most of my life and knows to a good extent what helps and what doesn’t and he presents options so I can make my own decisions regarding what treatment we’re going to next try. He has even called me to see if I could help another patient with something because he knew I wouldn’t mind him doing so. He once admitted that his patients are sometimes a bit more up to the minute on news than he is because we have more time to read news than he does at times. He’s matter of fact, but not rudely blunt. He’s funny at times. We have a connection in our background in that he did his pediatric rheumatology training at the hospital I was treated at. It’s even possible I was one of the cases he saw as a med student doing the rounds of clinic duty. I saw the head of the dept but he brought students in to see me quite often. Even more possible is that he saw my mother who was treated at the hospital he trained at.

    Both he and my pain doc are a lot alike. I am thankful for that because I know I am getting the best doc for me. My pain doc went so far as to tell me he couldn’t get rid of my pain. I knew going in that he couldn’t but having a doc admit it was refreshing. My pain doc and rheumy neither one went into a great amount of detail about side effects and some of the other med issues, but they knew I didn’t care if they didn’t tell me what I and they knew I’d go look up on my own.

    Some people found my doc a bit absent-minded but I never really noticed it to the point it was an issue. Others said he wasn’t too warm and friendly or he was too dry. Well, he did have a dry sense of humor but I found him friendly enough.

    He’s my doctor. If I want a friend, I’ll call a friend. It’s nice to like your doctor and to get along well with them but I don’t want to feel a forced friendliness from them. If they are friendly it’s a bonus.

  2. abcsofra says:

    I am about on the same page as you with an ra doc. My problem is always the last you mention with drs. that my treatment is up to me in the end. I have had several over the past 12 years that I have fired because they think it is solely up to them and if I don’t abide by exactly every medication they want me to take, I should go elsewhere. I do go elsewhere. I think this is a God like problem on their part but I don’t have a problem moving on. I just wish there was a straightforward way of prescreening docs to make sure they don’t have this feature. It sure would have saved me alot of money over the years.

  3. HayWire0831 says:

    My Rheumy has been voted one of the best doctor’s in America by the Rheumatology association (or whatever it’s called) every year since 1998, so I’m confident he knows what he’s doing. He also listens to me and if I ask to be tested for something, he orders it right up. He also answers my questions thoroughly and with confidence. He’s freaking awesome! He also offers meetings on how to live with RA (of course, they’re few and far between so I haven’t been to one yet) and he conducts clinical trials for RA patients. He’s totally awesome and I hope I can continue to see him for a good length of time.

  4. SjogrensStyle says:

    I really like my rheumatologist because he speaks to me like a peer, knows that I’ve done my research, and says things like, “Just because you are sick doesn’t mean that you have to feel awful all the time. There are always new things we can try.”

  5. Meredith says:

    I guess I have to respectfully disagree on this one. I have had 5 Rheumatologists and the best ones were ones that I connected with on a deeper level than professional. They remembered the facts about me and my disease. I didn’t have to reiterate my history every time I had an appointment and they cared about my condition in a different way than others. If I am in pain, but my RA seems quiet on my physical exams my current Rheumatologist will tell me that she thinks I’m doing well. She completely discounts my reports based on her own observations. I feel like they all can read blood work reports and recommend treatment options. It is someone special that sees the person before them and does their best to help you live the best life possible. That is why I am changing my Rheumatologist. When you have a chronic illness, I believe that your relationship with your doctor is a significant one and I don’t plan to stay in a failed relationship.

  6. RA Guy says:

    @Meredith, don’t get me wrong, I have a wonderful relationship with my current rheumatologist, and wish the same for everyone. The main point I was trying to make was one of expectations. I used to carry so many expectations into my first meetings with rheumatologists, that looking back it’s no surprise that many of them didn’t work out. Once I clearly figured out exactly what I was looking for–at a minimum–I ended up getting more than I could have ever hoped for. And when it came to emotional support and validation, I made the personal decision to look for this elsewhere. That’s all I was trying to say. :-)

    And I totally understand your point, about basing treatment on more that just what the numbers/labs say. As I mentioned, I’m seronegative myself and despite the fact that my labs always look ‘perfect’ (except the instances where I had elevated liver enzymes), my current rhueumatologist has never doubted that I have RA.

  7. Caite says:

    I totally agree with this, as it pertains to finding a doc to treat my arthritis and fibro. I’ve finally found someone who will accept my definition of what normal is, and is willing to do anything she can to get me back to what I want in life. As others have said, if I need some pity and cheering up, I’ll call a friend. If I need someone to help me find a solution to a medical problem, I’ll call my doctor.

  8. Carla says:

    RA Guy: I agree with your post and I, too, am lucky to have found a great doctor that I both enjoy and respect. The only other criteria I might add, is that I want my doctors to treat me as a whole patient — they have to understand that I have other medical needs other than what I’m seeing them for.

  9. Shan says:

    RA Guy – perhaps you read my entry on ‘The Meaning of Pain’?! You know we disagree on this point. Psychological well-being is part and parcel of any chronic condition, and they as professionals in this area should recognise this and manage it accordingly – whether or not that be a referral to a psychologist. Not only when the doctor medicates the pain I think they should also be take the time, and be realistic, about the other aspects of managing RA. As Carla mentioned above, we are people too and we needed to be treated as ‘whole patients’. Sometimes we just want to be heard and you’d think they would be the best people to listen. What do we pay all the money to them for after all?

  10. Candee says:

    I see an interesting parallel RA Guy. Corporate vs Medical, professional vs. personal. I think back to my years in corporate and this is what I come up with: I was on a team of “professionals” who trained branch banking staff how to “interact” with customers. Not “empathize” but “interact”. My supervisors had my career in his/her hands and did not empathize with my pain/distress of RA which I didn’t know I had at the time. Every Rheumy who has treated me thus far had my pain/condition in his/her hands and has yet to show true empathy. The customer service trainer in me screams “I can teach you how to do this!!!!” do what? interact WITH empathy. It’s really not that difficult. Your fellow professional/personal suffers are right here to do just that right beside you…sending gentle hugs your way. Candee

  11. Candee says:

    p.s. your post is an important reminder to us all that to have any shred of inner peace with treatment, we have to honestly examine our expectations.

  12. Megan says:

    What you describe in the second half of your post—a doctor who listens to you and takes your opinion, decisions, and experience seriously—is what I think many of us mean when we say we want a compassionate or empathetic rheumatologist. Because unless a doctor is willing to listen to our “testimony” (for a lack of a better word) regarding pain levels, fatigue, etc, particularly if we are seronegative, he/she is frequently going to send us out the door, insisting that our symptoms are under control and/or we are making a big deal out of nothing. Simply agreeing with a diagnosis doesn’t necessarily lead to an open dialog between doctor and patient, where the doctor takes the patient’s self-report seriously. Perhaps “holistic approach” is a better description for this kind of doctor, who interprets lab results and examinations alongside the patient’s observations and opinions.

    I feel the same way about the dentist– if a dentist is going to discount my self-report about pain levels and, say, refuse to wait until a lidocaine injection has fully numbed my mouth before beginning a procedure, I have no interest in continuing that professional relationship. I see that as analogous to a rheumatologist who insists I cannot be fatigued or in pain because my ESR or RF is “too low.”

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