InsightHostKJ> How are you doing Dr Waters?

DrWaters> Still recovering from a cold, but OK.

InsightHostKJ> Since it is a small crowd, do you want to do an open discussion?

DrWaters> OK

InsightHostKJ> you gave your cold to me Dr Waters!

DrWaters> Never kiss your keyboard.

InsightHostKJ> OK..tonight's discussion is Dr Patient Relationships

InsightHostKJ> LOL!

DrWaters> You start KJ

InsightHostKJ> Dr Waters you want to start by telling us some things we can do to improve these relatioships?

DrWaters> Be nice to your doctor. Try not to overwhelm him/her with too many things at one visit. Don't call office (except for refills) unless it's to make an appointment or for a real emergency.

InsightHostKJ> What is a REAL emergency?

DrWaters> A bad reaction to a medicine. A really unexpected worsening of ones symptoms. A new illness that may cause problems with the arthritis med's.

InsightHostKJ> Okay...sounds fair to me

DrWaters> Not to remind me that your knee that's been hurting for 10 years still hurts.

InsightHostKJ> What is the worse thing a patient can do to jepordize a relationship with a doc?

InsightHostKJ> LMAO

InsightHostKJ> but it does!

DrWaters> Be dishonest, just like any other relationship.

InsightHostKJ> (Everyone this is an open discussion...feel free to jump in)

Heidi> What is it's someone from out of town who needs a doctor and calls you for the first time with a serious problem?

DrWaters> Anyone can be seen in my office at anytime, but then I'm a nice guy.

InsightHostKJ> Not all doctors are so nice?

Melanie> I feel that newly diagnosed patients need close appointments and a person to call with questions. Why don't rheumatologists build that in somewhere for us?

DrWaters> Many aren't.

InsightHostKJ> Melanie...I am working on a proposal for my RD to hire me part time as a patient education nurse...as soon as i get on the right dmard combo

Melanie> That would be great. Its really needed.

DrWaters> I feel close appointments are great. But a doctor can't work for free, and we can't charge for phone calls. SO phone calls are not the way to go.

TRANSAM> My doc doesnt want to see me anymore cause I disagreed with him. HAvent been to a RA doc in 3 years and Im disintigrating

Melanie> I can see that. KJ is onto something though.

Heidi> I had a problem like trans too

Marcia> I had 2 cancel my appt. with my rheumy. I have called 5 times 2 reschedule and they always tell me they will call me back with an appt. What is the best option that I have now to get an appt? without making anyone mad at me?

DrWaters> Most patients don't want to talk to a nurse. Information availablility is not the issue, it's a time to talk with a doctor that is.

Melanie> No, I think its the information we really want. It helped me to talk with my rheumy's nurse.

DrWaters> Let's pause for a sec so I can address the comments that have been made.

DrWaters> People deserve to have their opinions respected. It's their body. I can disagree with my patients and try to persuade them to do the right thing but I can't hold it against them for having a divergent opinion.

Heidi> divergent

DrWaters> Divergent = different

Heidi> The last Reumy refused to treat me when I told him I wouldn't take Prednizone

DrWaters> Secondly, why would a doctor not want to see a patient in the office. Being with people is fun and when you're a doctor you even get paid to do it.

Melanie> lol Not all share that opinion.

Nubby> some of the hmo doctors don't really care if they see people or not

DrWaters> I wish more of my patients would refuse to take Prednisone. Can you move to Florida. Or yeah, we have Anthrax here.

Nubby> LOL

InsightHostRon> is that worse than RA??? LOL

InsightHostKJ> it's a cure for RA ron

InsightHostRon> ahhhh

Heidi> lol

DrWaters> I see HMO but I'm not capitated. You don't want a doctor who's capitated because then they are paid NOT to see you. It's a scam.

Nubby> LMAO

InsightHostKJ> How do we find out if they are capitated?

Heidi> I don't understand capitated

DrWaters> Ask them if they are fee for service or captitated for YOUR SPECIFIC INSURANCE PLAN.

silverpixie1uk> what do you say to a DR that tells you its all in the mind because your bloods come back with only a slight raised ESR

DrWaters> It's important that you know the captitation status.

InsightHostKJ> can you explain capitation?

DrWaters> Let's do the normal ESR first.

Kimmy> capitated doctors still have their heads...as opposed to "de"-capitated doctors...

InsightHostKJ> LMAO

Melanie> A lid on payment - chronic patients eat up all the profit. Easier to not see them than lose profit and time.

Melanie> lol Kimmy

InsightHostKJ> i've seen a few of those!

silverpixie1uk> mine needs de-capitaiting...lol

DrWaters> I tell my patients that the body is complicated and there's a lot we don't understand about pain. While I'm sure the pain is real we can't find a specific cause so we'll have to resort to trial and error as far a treatment goes.

InsightHostKJ> so you beleive all pain is real?

DrWaters> If the patient refuses to understand that not every cause of pain is diagnosable, then it's the patients poor cooperation.

silverpixie1uk> i get depressed because of the pain the doc seems to think that its the depression causing the pain

Heidi> one feeds on the other

DrWaters> Pain is what one perceives. Unless one is malingering for financial or other gain intentionally, all pain is real.

InsightHostKJ> and if we get the feeling our doc feels otherwise, is it time for a change?

DrWaters> Pain causes depression much more often than depression cause pain.

DrWaters> Absolutely.

InsightHostKJ> Hi John, we are talking about doctor-patient relationships

InsightHostKJ> what about those docs that are good at what they do but have no bedside manner

silverpixie1uk> we have such a shortage of rheumatologists here in the Uk it takes months to get to see one

Heidi> What about when a doctor just doesn't believe the patient

DrWaters> Actually, you may not need to change doctors. You just need to remind them that you really don't want to be sick and he needs to have trust.

InsightHostKJ> my ankle surgeon has the personality of a door

silverpixie1uk> so we have to put up with non believing GP

DrWaters> Doctors are very open to logic. You patients need to get our brains (and personalities) fixe-up sometimes.

DrWaters> Fixed-up.

InsightHostKJ> straighten ya out a bit?

Melanie> When I initially saw a rheumy, I was too sick to worry about how he was doing. Changed rheumys a short time later though.

DrWaters> Did you tell your ankle surgeon that even though you respect how busy he is that you're a very outgoing person and that to you it seems rude when someone dosen't make converstion?

john> I have finally found a Dr who recognizes pain as a disability

InsightHostKJ> no..i've tried to draw him out though...didnt work...

InsightHostKJ> thats great john

kjcatty> What about rheumatologists who only want to discuss RA and not other issues and health concerns that are related?

Heidi> My Dr. is so busy all the time with at least 1 hr wait that I forget what I wanted to ask or I feel guilty taking up so much time

DrWaters> I have an interesting approach, speaking of disability. I tell my patients that it's my job to have 100%% faith that they will get better. Because of that I CAN"T be objective about diability and I won't assess that. They need to see a doctor that evaluates them ONLY for disability satus for that purpose. That way patients understand that in my office we never call it quits.

InsightHostKJ> i like that

Nubby> I do too.

silverpixie1uk> we have to wait 3 weeks to see a GP here unless its an emergency by that time my flare is getting better

Heidi> If a person wants to file for disability do you refer him to someone else

DrWaters> Most people hate it and think I'm a jerk. That's why this doctor-patient relationship stuff is so weird.

InsightHostKJ> Different strokes for different folks

Melanie> Yes, I wouldn't like that. I may not be able to work, but am far from giving up on treating and beating RA to its knees (not mine).

kjcatty> At least you are up front in the beginning...

john> with fibro arthritis and osteoporsis, pain is a consideration ideration

DrWaters> If someone files for disability I provide copies of records, which usually make it perfectly clear to everyone but the government and lawyers as to how disabled they are, but I refer them to someone else for an "official" report.

InsightHostKJ> disability is a very tough issue because we all have differnt views on it

Melanie> True enough.

jo> GDay DR Waters and friends Jo in Australia

TRANSAM> Night and thanks for the info Dr Waters.

kjcatty> I am an attorney. Evaluate SSD and SSI and I don't know how I feel about it always.lol

InsightHostKJ> LOL kj

Melanie> lol

Nubby> kj can you explain how you do feel?

kjcatty> Sometimes I am sympathetic..other times I hard sell

InsightHostKJ> for me, on a personal level.....filing would mean giving up...but i dont feel that way about others TEXAS> If one's doc says that one is "end-stage" and ready for kidney failure next, Dr Waters.Is it ok to cuss him and then fire him??????

InsightHostKJ> Hwy swimmer...we are talking about dr patient relationshipd

swimmer> great

kjcatty> I think it is a very personal thing too. People need to know when they are unable to deal with full time postions. Doctors can help their patients sort that out better than lawyers I think.

DrWaters> The whole disability thing in the U.S.A. is stupid because what the patient FEELS carries no weight and that's the most important thing of all. That's the real reason I refused to lower healthcare to the legal level (and that's low).

kjcatty> Thanks a lot doc..some people feel that some of us help lol.

Melanie> Now that I understand.

silverpixie1uk> do you think its fair to an employer when u dont know what each days gonna bring

Heidi> I tried to get SSD but they said I was 4 quarters short. I got stuck between a rock and a hard place

jo> well we are lucky here in Australia then as the PT has a lot of say when to stop work ect

InsightHostKJ> that sucks heidi

DrWaters> "end-stage" is just an euphemism for worthless piece of crap.

Heidi> it sure does, I had to ake an early withdrawel on my small IRA

DrWaters> That's what I mean. If someone KNOWS they are too sick to work how do I know they aren't?

InsightHostKJ> should a doc ever tell a paitnet they are end stage?

kjcatty> I agree with that.

TEXAS> I felt like he was calling me that, Dr Waters...He doesn' t know how I have fought all these years and am better for it

Nubby> you don't.....maybe give them disability for a short time and then check back from time to time

DrWaters> Let's get off the disability thing and go to other problems you have with doctors.

kjcatty> End stage...RA?

Nubby> whats end stage RA?

Heidi> How do you tell a patient he is dying

TEXAS> Ra, Osteo, Fms, Heart prob from Enbrel

Melanie> Getting more than one doc who is treating you to talk with or share info about you. What can we do to help with that?

jo> I have a great relationship with my GP wouldnt swap him for the world

kjcatty> Thanks Melanie...that was my biggest problem last year. Had to go to Mayo to get docs to talk to one another.

TEXAS> Some of us don't , Jo

DrWaters> Let's talk for a second about BAD NEWS like end-stage or dying (though dying isn't always as bad).

Melanie> I've had it too. Constant challenge to get info back and forth.

InsightHostKJ> ok..

TEXAS> please do

DrWaters> A doctor has to always try to give their patients HOPE while still maintaining an HONEST relationship. It's a tough thing to do.

kjcatty> How do YOU balance?

DrWaters> If someones RA is really terrible and every joint is destroyed a doctor could be sympathetic and honest by saying "DMARD's won't really help you anymore, so let's talk about helping your pain".

InsightHostKJ> that would be nice

Melanie> That's very good.

Melanie> It might take more if the patient was going to need Hospice care or something along that line though.

kjcatty> How about RA that has attacked organs like lungs/kidneys...how can that be explained.same way?

DrWaters> Or if someone is likely to die the doctor could say, "Most people with your problem don't live very long, but there are exceptions. More importantly though, let's talk about your fears and how we can make whatever happens as tolerable as possible."

InsightHostKJ> very good

silverpixie1uk> i would like that the truth

DrWaters> Hey, I wish I could think of these cool lines when I'm in the office.

TEXAS> I think that would be more helpful, thanks

Melanie> I like that too. I wish my mother had had a doctor who was that understanding and compassionate.

InsightHostKJ> LOL write em down! Quick!

TEXAS> Quickly, Indy....Velcro!

DrWaters> Now let's talk about personality.

InsightHostKJ> okay

Melanie> You mean how sweet and gentle and patient we are when in pain. lol

InsightHostKJ> ours or yours?

kjcatty> lol...you stole my question...sorry

swimmer> LOL

InsightHostKJ> lol mel

DrWaters> Everyone likes different types of people. Some people judge a doctor by their fancy suit and office and expensive car. Some like doctors that tell dirty jokes. SOme like doctors that are sensitive and mushy. Some like doctors like me that are eccentric. You need to find someone that matches YOUR personality type.

InsightHostKJ> and it is okay to doctor shop until you find that match?

DrWaters> Definitely.

silverpixie1uk> i think of our docs like animals ones a quiet little mouse another a grumpy grizzly bear...lol

Melanie> I see a female rheumy who is blunt, quick and not liked by many. I think she is great. lol

swimmer> what do you like in a patient? Or what types of patients do you dislike?

TEXAS> Ohhh!!!! Intelligent, verbal, quick, and quirky

silverpixie1uk> what does that say about you mel....lol

Heidi> How do you find a doctor that will believe you when all medical logic says you are wrong

Melanie> I'm scared to think about it, pixie.

InsightHostKJ> good question swimmer

DrWaters> Or you can let your doctor know what you like and maybe he can fake a different personality for you. But the PATIENT needs to communicate what they need personality-wise from the doctor.

InsightHostKJ> the doctor wouldnt be offended?

DrWaters> Almost never. We need to be liked, too.

InsightHostKJ> doctors are people too huh?

DrWaters> Let's talk about what turns doctors off.

InsightHostKJ> okay

DrWaters> People that always see the negative in everything and never the good turn doctors off the most.

InsightHostKJ> understandable

TEXAS> Eeyor people...lol

Heidi> How about when the patient is positive AND THE dR. IS NEGATIVE

DrWaters> All, dishonesty, as already mentionned. Like can you LIE on my insurance form for me.

silverpixie1uk> but its hard to be positive when youre hurting bad

InsightHostKJ> but there are times when the pain may be so bad it is not possible to see the good

DrWaters> If everyday is that bad that there is not even a little good, it's hopeless.

Katie> one must always have hope

kjcatty> Couldn't seeing negatively be a sign of depression though Dr.. Waters?

silverpixie1uk> but its not everyday maybe just that day

DrWaters> If somedays are that bad but somedays you can see some good, the doctor has to be supportive.

DrWaters> Seeing everything negative is usually a sign of deoression. Smart for a lawyer, huh?

kjcatty> Thanks,

DrWaters> Depression.

Heidi> so is my Dr. depressed

InsightHostKJ> LOL Heidi!

silverpixie1uk> lol heidi

TEXAS> lolol Heidi

Melanie> Do you feel most rheumatologists you've met are pretty on target with patients? Seems like a lot of negative posting here about initial experiences.

Many doctors are depressed. We sometimes need our patients to cheer us up.

Melanie> LOL Heidi

swimmer> so, learn a joke before you visit the doc?

kjcatty> I would think treating chronic pain and degenerative problems would be stressful and depressing...

DrWaters> Or at least flirt a little with the chubby, balding doctor.

Melanie> lol

InsightHostKJ> LOL Dr W

kjcatty> lol

PromiseMe> lol

swimmer> LOL

wayney> lol

silverpixie1uk> our rheumy says he feels helpless sometimes

TEXAS> Dear Lord, He'll run for cover and think "Malpractie suit" Poor thing

silverpixie1uk> when he treats the young ones s

InsightHostKJ> LOL Tex

Katie> my rheumatologist told me that the hallmark of a patient with aggressive RA is the patient being worried for the rheumatologist.

wayney> my female dr might not like me flirting with her either

DrWaters> Being a rheumatologist is very upbeat and fun because the pateints are truly ill, can often be helped (even if it's just helping their pain) and it's an important job.

JBug> Well, I've been training my rheumatologisy for 27 years, and I'm not done yet! But I DID teach him to laugh!

kjcatty> My doctor and I humor one another...she teases me into doing what she wants and she can usually tell when she has pushed to far when my retorts are a little smart a**

Melanie> lol

InsightHostKJ> Dr Waters, your patients are truly lucky to you have and so are we!

kjcatty> I count that as one of my accomplishemnts too...14 years to do

JBug> lol

Melanie> I agree, KJ. I appreciate honesty and humor.

DrWaters> Well, I have to go. Please try to communicate your wishes to your doctor. You might be more articulate and social than your physician. Remember, we were the nerds in school.

TEXAS> Many thanks, Dr. W

swimmer> that puts things in perspective LOL

Heidi> Thanks Dr. Waters

Kimmy> thanks Dr. Waters...

Katie> lol

InsightHostRon> LOL.. Thanks Dr Waters... Another good chat...

silverpixie1uk> lol DR Waters

JBug> Well said, Dr.

InsightHostKJ> Thank you!!!

Melanie> Thanks Dr. Waters. I really appreciate you!

PromiseMe> thanks you dr waters

Katie> thank you Dr. Waters

swimmer> Thanks

kjcatty> Thanks Dr.W

DrWaters> Thanks. Good night all.

silverpixie1uk> ty Dr.

InsightHostKJ> Good night