Your Health Care Team: More Than a Doctor and Nurse
A variety of professionals will help you fight arthritis.
As you manage your osteoarthritis, rheumatoid arthritis or any of the numerous arthritis-related conditions, some of your most valuable relationships will be with members of your health care team. Together, you’ll monitor the progress of your disease and day-to-day function, and find the treatment plan that works best for you.
Finding the right doctor is key to creating a successful doctor/patient relationship and getting optimal care. Discard the old idea of blindly following doctor’s orders without discussion or question. You can – and should – take the lead role in your care. You’ll need to find someone who not only meets high standards of medical knowledge and skill, but who also works well with your personality. Your relationship with your doctor should be a trusting partnership with open communication.
The doctor’s philosophy of practice should mesh with your own expectations and style. Ask how involved patients are in decisions, the level of aggressiveness in treatment if you have an inflammatory or autoimmune disease, and how much attention is given to your overall quality of life and health.
Let's meet the many different types of health care professionals who will help you:
Primary care practitioner. For most people, even those with arthritis or related conditions, the main medical professional they see is their primary care doctor. Most likely, he will first diagnose your condition but may refer you to a specialist for evaluation and potential diagnosis. From there, he will continue to handle most of your care. Think of it this way: If you’re the general manager of the team, your primary-care doctor is the head coach. His practice may include other generalists, such as physician assistants, registered nurses (most likely) or even nurse practitioners.
In some cases, when you need occasional or ongoing specialized medical care – for monitoring, resolving a problem or a complication, or for certain treatments – you may see or continue to see other health professionals. These specialists are an ongoing part of your team.
Rheumatologist. This physician is a specialist with advanced training in arthritis and related musculoskeletal conditions. Your primary care doctor may consult a rheumatologist or refer you to one if she’s uncertain what type of arthritis you have or if you need ongoing specialty evaluation and treatment. The rheumatologist and your primary care doctor should update each other regularly, so they each have a complete picture of your current health.
Orthopedic surgeon. Also known as an orthopedist, this doctor specializes in musculoskeletal issues, including arthritis (particularly osteoarthritis) and injuries. An orthopedic surgeon is trained to perform surgery on joints, bones, muscles and other parts of the musculoskeletal system, so you’re likely to see one if your joints are damaged and you need a surgical procedure, such as a joint replacement. Orthopedic surgeons, or orthopedists, also focus on diagnosis, treatment and management of musculoskeletal problems. In fact, some orthopedists do so exclusively, choosing not to perform surgery in their practices.
Osteopathic physician. These doctors, also known as osteopaths or DOs, or doctors of osteopathy, have training equivalent to medical doctors, or MDs, but a different overall philosophy. Diagnosis and treatment stem from the idea that many illnesses are connected to disorders in the musculoskeletal system. Some of these doctors to focus more on prevention and overall wellness than on treating disease, which, in contrast, is the focus in the traditional medical model. An osteopathic physician may be your primary-care doctor, or an osteopath may be a specialist, such as a rheumatologist.
Nurse practitioner. These professionals have advanced education and clinical training, providing these health care professionals with the expertise to manage patients’ overall care. They can be primary care practitioners, and can practice within a setting of physicians and other professionals or independently. They can provide diagnosis, medical care, medication and patient education. Some nurse practitioners are trained in specialty fields, such as rheumatology.
Physician assistant. These health care professionals provide care, such as physical exams, diagnosis and medications, as part of a physician practice under the supervision of a medical doctor. They do not provide care independently.
Registered nurse. These highly trained nurses work with the doctor. A nurse is likely to provide patient education materials and to explain how to follow the treatment plan your doctor prescribes. Some registered nurses specialize in rheumatology.
Pharmacist. These health professionals are licensed to dispense medicines. Pharmacists fill your prescriptions and can explain how medications work and counsel patients on drugs’ actions and side effects, as well as evaluate the potential for interactions among other medications you take. They can answer questions about both prescription and over-the-counter medications.
Physiatrist. A physiatrist is a physician who has additional specialized training in physical medicine and rehabilitation. This type of doctor may oversee your physical therapy program.
Podiatrist. These doctors have special training in diagnosing and treating foot problems such as bunions and hammer toes. If osteoarthritis, rheumatoid arthritis or another form of arthritis or injury affects your feet, you may see a podiatrist for evaluation and treatment, including orthopaedic inserts for shoes, as well as good surgery.
Psychiatrist. These medical doctors are specialists in mental health. They can evaluate, diagnose and prescribe medication for related problems, if needed, but not all of them do therapy. They can usually refer their patients to psychologists or other sources of help.
Occupational therapist. This health care professional has training to help patients reach their highest level of independence in daily activities. An occupational therapist can teach you how to reduce strain on your joints during daily activities and can fit you with splints and other devices to give your joints a much-needed rest.
Physical therapist. This professional is trained and licensed in rehabilitation techniques. Physical therapists can help restore function and prevent disability for people affected by arthritis. They can also design exercise programs to help reduce pain and improve the functioning of parts of your body affected by arthritis.
Psychologist. These professionals have specialized education and training in behavior, human psychology, therapeutic methods and counseling in one-on-one therapy or group therapy. Some psychologists have additional training or experience in the emotional challenges and coping issues related to chronic illness, life changes and relationships. People may call themselves “a therapist,” but may not have any specialized education or training. State requirements for practicing psychologists vary. Some require a license to practice.
Social worker. A social worker is licensed to help people deal with the impact of chronic illness on their lives. Usually this involves helping people connect with social services and other types of assistance. Social workers also can help find solutions to social and financial problems related to your disease.
Acupuncturist. Trained in traditional Chinese medicine, acupuncturists seek to balance the body’s vital energy, known as qi (pronounced “chee”), which is thought to be out of balance when you have a disease or illness. Acupuncture may help reduce pain for some people with osteoarthritis, rheumatoid arthritis and fibromyalgia.
Chiropractor. Also known as doctors of chiropractic, these health professionals are not trained or licensed as medical doctors, but instead are trained in the practice of spinal manipulation and other physical techniques. They may be helpful in relieving the pain of certain back problems. People with conditions like osteoporosis or who have a complicated medical history should talk to their medical doctor before getting treatments.
Teamlet. With too many patients leaving their doctor’s offices confused, dissatisfied and not receiving the recommended care for their chronic diseases, an increasingly popular approach is the “teamlet,” or little team. A teamlet consists of a health coach and a doctor. It’s similar to the system for primary health care that’s used in England, where doctors rely on nurses to provide most chronic and preventive care and to do routine tasks like refilling prescriptions.
The health coach meets with the patient before the clinical exam to determine priorities for the visit, take a basic history, check on medication use and order lab tests. Then the coach stays in the exam room while the doctor is working, partly to assist the physician with procedures and paperwork, but also to help the patient by recording important details of the visit and keeping the visit in line with the patient’s priorities.
After the exam, the health coach remains behind to make sure the patient understood what took place and what they need to do to improve their health. They may also “close the loop” by asking the patient to repeat back their understanding of each item of advice given during the visit.
Don't Be Afraid to Ask for Help
Also remember that you may benefit from additional help outside the health care system. If you're trying to improve your overall health as a way to help combat your arthritis symptoms -- always a good idea -- you’ll be more successful if you don’t try to go it alone. In fact, study after study shows that people who receive professional counseling or support are more likely to maintain their emotional well-being and to achieve health goals, like losing weight, quitting smoking or sticking with an exercise regime.
“Professionals such as psychologists or personal trainers have years of experience and training under their belt, so their advice is likely to be more effective than that you’d receive from a well-meaning friend or family member,” says psychologist Simon Rego, associate director of psychology training at Montefiore Medical Center in New York City, and assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, also in New York. Plus, adds Rego, “Spending your hard-earned money is incentive alone to follow through.”
Here are three different types of professionals to call upon to help you be a better ‘you,’ and how to find each one:
- Personal trainers can help you establish a workout regime, make sure you’re doing each exercise move correctly and motivate you to stick with your workout. Visit the American Council of Exercise (ACE).
- A weight loss physician (bariatrician) specializes in assisting obese individuals to get their weight to a healthy level, while also treating and toring weight-related problems like arthritis. Find one through the American Society of Bariatric Physicians.
- A dietitian can determine how many calories you need and whether your diet is deficient in certain nutrients, then devise an eating plan that meets your goals, like losing weight or getting your blood sugar under control. Visit the American Dietetic Association.