I like my Rheumy because he offers additional advise. He listens to me & offers advise on exercise, diet, supplements, alternative explanations on why certain ligaments or joints "may" be aching at the time. Plus I don't have to always go "into the office" to see him, I can email & he responds within 24hrs on almost anything I ask. Which is weird? Because you'd think all doctors would want the $$$ of you coming into the office.

I also like him because he's not a "doom & gloom" doctor either. Not everything is about, "Take this 5,000mg of death, you'll never get better, everything is going to fail" type doctor either. He's very optimistic & even shares new info on new classes of drugs in testing etc.

The first real rheumatologist I had, who treated me for 14 years, till I moved provinces just filled in prescriptions. He was the old style type doctor, and very laid back (read lazy?). In fact, once the provincial insurance set up and evaluation for the biologics by trained nurses, I really never saw him at all, if my meds were working. I went 4 years and never laid eyes on him, till my liver enzymes got so high, he had to switch me to Sulfasalazine.

When I moved, I was given a younger doctor, who was challenged by the severity of my disease. He has worked hard, and done unconventional things with me. Like putting me back on mthx after 7 years of being off of it, once I had seen a liver specialist. He also puts up with me pushing him to raise my mthx dose. He examines each joint, carefully. My old rheumatologist rarely looked at my joints. What kind of rheumatologist does that?

The fact is, when mthx started failing, I had another doctor and he gave me the CPS, because he figured it was probably other meds that were affecting me. I read up on every drug I was on. At the time, that was 22 meds, including 3 asthma drugs. I was able to get down to 9 meds, once I figured out what all the meds were for, including treating the side effects of other drugs. That was the best doctor I ever had. He was willing to discuss my findings, argue with me, persuade me, and in the end, help me chart a course.

I would really like to go back on Kineret, instead of Orencia. But, my current rheumatologist convinced me to stay on Orencia. I listened, because the fact is, Orencia will fail some day. Maybe a year, or ten, but then, I can go back to Kineret, since there are no biologics left.

It really is a give and take, and you do have to educate yourself. But, you do have to still work with the doctor, and in the end, he is the one prescribing, so he is the one who wins. More or less! Because if the treatment works, then we feel better, and I guess that is the goal.

I research and read everything I can about the disease and the meds to treat so that when she makes a recomendations I am already somewhat knowledgeable. But in truth she calls the shots but I do challenge her regarding her decisions.

We deserve to be partners in our health care. We deserve doctors who recognize that and are not threatened by it.

http://tinyurl.com/MirahRA-video

I'm all for collaborative relationships, and I want to have some input into decisions, and I'm glad that, as a whole, society has moved away from the idea that medical professionals are godlike and infallible. But let's not kid ourselves, we can't equate their years and years of training, and their ongoing learning, with a couple hours spent looking things up on the internet. I realize many patients spend far more time researching than that, and I'm oversimplifying, but come on, there's no comparison.

My mechanic will sometimes give me options, but those decisions tend to be based on my financial situation and long term plans for the vehicle. I don't for one second imagine that I know more about my car's engine than she does. That's why I took some time and did some research to pick the best mechanic I could find. If you think you know more than your rheumatologist about the actual disease or about the available meds, you need to find a new doctor, or go ahead and become one yourself.

What we ARE undeniably expert at is our own bodies. We can keep accurate records that can be a huge part of the process of finding the appropriate protocol. We can give feedback that can't be acquired in any other way. In that sense, yes, we should absolutely think of ourselves as partners in decision making. And of course we deserve to get clear and thorough explanations. But yeesh - my rheumatologist just spent a week at a conference learning about the most cutting edge info on RA. And that's on top of her medical degree and her years of practice. I will speak up about how my own personal body is doing, because I know more than she does about that. But I trust her for the rest of it. Sure, she can sometimes present options for me, and if she explains the pros and cons of each, I can sometimes make decisions. But overall, I've got to have trust in her and respect for her skill set.

Years ago my family doctor presented me with two options and asked me to decide - nothing related to RA, at the time - and I said hey, I'm the least educated person in this room, medically speaking, and I'd really like an informed recommendation here, what's with the 'you decide" stuff? His answer was that doctors are often covering their own butts from lawsuits: if the patient thinks they've made their own decision, they're less likely to come after them later.

And please note, I'm not challenging one single thing any previous poster has written. I actually have a bug up at the moment about a neighbor who is positive she knows more than the doctor who is trying to get her out-of-control diabetic issues settled down, so I guess I'm on a bit of a soapbox at the moment!

I completely agree that at the end of the day the rheumatologist's training is going to trump my understanding of the disease.

Still, I believe we as patients need to be proactive and learn everything so that we can make an informed decision.

Case in point: I have latent TB. Biologics are contraindicated for people like me UNLESS you undergo TB treatment before starting the biologics. But then, treatment of TB in not advised in people over age 50 unless they have active TB.

So after 10 years MTX lost its efficacy. Only option was biologics, which no one would recommend. I took the bull by the horn and did my research, even went to the top TB specialist cross country at Johns Hopkins for a consult. [I'd been exposed to TB around age 5....I was 55 when I consciously chose to take a biologic.] I learned that he'd seen patients whose latent TB activated 75 years after exposure.

Armed with information [albeit unfavorable] I went back to my rheumatologist, also highly regarded in the US field of rheumatology. I told him what I'd learned but that in spite of it all, I still wanted to go on biologics because I couldn't deal with the worsening of RA. He mulled it over and called me a few days later and asked me to take a blood test for TB to see where we stood. I did. My count was almost negligible.

After he sat me down and educated me on every possible symptom of TB, warned me that if I showed one of them that I was coming off the biologic, we both agreed to start Humira.

That collaborative relationship, coupled with mutual trust, paved the way for an unusual treatment option for a person with latent TB. And thanks to that relationship, I've been on the drug for about 15 years. It's changed my life.

What it all means is that you have to cultivate a mutual respect with your rheumatologist. You have to educate yourself as much as possible regarding your disease. You have to assert your needs. You need to listen to the expert when your ideas re treatment are not suitable. And the rheumatologist has to be totally open to this kind of relationship.