The First Rheumatology Visit – What to Expect

If you’re like most chronic illness folks, you’ve been waiting quite a while to get in to see a Rheumatologist for the first time. The shortage of Rheumatologists is palpable throughout the journey, and finding a good one is worth the wait. The wait is, however, quite difficult and feelings of overwhelm and being lost, scared and worried can rise up quickly. Concerns about new diagnoses, the unknown journey ahead, and guaranteed lifestyle changes are valid and understandable. Accurate expectations of what your first visit will be like will go a long way to settle this tension and thankfully, there are some things we need to get done during the wait anyway. So, the time isn’t all lost and the diversion is healthy.

Let’s dig in.

The Exam

During the exam, the nurse will reconcile your medication list and type in the main reason for your visit. Be sure you know what medicines you take – prescribed and over-the-counter – and know why you scheduled your visit:  To begin the journey of a possible autoimmune diagnosis for your chronic pain, fatigue and other symptoms.

The doctor will press and feel (palpate) each of the small joints on the hands and feet for presence of pain and tenderness. Other joints will likely be assessed such as knees, ankles, shoulders, and any other place you state there is pain, tenderness, redness, swelling, etc. This part of the exam is really two-fold. First, it lets the doctor know where your symptoms are located and how you describe pain severity in different areas on your body. Secondly, it serves as a baseline to which future visits will be compared as the course of your illness and followed. 

The baseline is extremely important and it’s also important that you not hold back (nor exaggerate) how bad your pain is. Your thoughts about how much it hurts, how well (or not) it responds to things like heat, cold compresses or maybe Tylenol, will prove useful to the diagnostic process. Often, the clinic will have a 1-10 pain scale graphic hanging in the room and you may find this useful. WebMD offers a great approach to reporting pain or other symptoms to your doctor – Do Ask, Do Tell. Your physician will guide you in how to determine whether a symptom is something to pay attention to, or is something non-related, or just a new finding of normal stuff now that you’re really tuned in to your body and how things are feeling. I promise, you will now be tuned in to everything that happens in your body. Even things that have been working as advertised for years will seem like some weird, brand new out-of-the-ordinary symptoms simply because you’re now dialed in to it so closely.

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