What Do You Look For In A Rheumatologist?

RA Guy Adventures of RA Guy

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!