Working With Your Healthcare Team

Once you have begun to build your healthcare team, with referrals to professionals like rheumatologists, physiotherapists, occupational therapists, and/or orthopedic surgeons, there are steps you can take to make the most out of the time you spend with the members of your "team".

Working with your rheumatologist

Rheumatologists are medical doctors who have many years of additional training, on top of their regular medical schooling, to become specialists at diagnosing and treating arthritis. People living with arthritis will often comment that their rheumatologist is the most important healthcare professional in their lives, and that this doctor-patient relationship is critically important to them.

For many people, getting referred to a rheumatologist at all can be a real challenge. In Canada, we face a critical shortage of rheumatologists: there are fewer than 270 in the country to care for the approximately 4,500,000 Canadians living with arthritis. Obviously, not everyone with arthritis will have access to a rheumatologist - see getting a referral.

Once you have your referral, it is extremely important to make the most of your time with your rheumatologist. Because they are in such high demand, appointments can at times be shorter than you might like them to be. Here are some ideas for getting everything you can out of the appointment:

  • Make a list of the three most important questions you want to ask your doctor. You don't want to remember the most important thing you wanted to ask the doctor as you are driving home from the appointment.

  • Bring a support person with you to your appointments, especially at the beginning of your disease experience and when you are trying to build a treatment path suitable to your health goals. This can help the close people in your life to understand the seriousness of your disease, and give them the opportunity to ask questions. It also provides you with someone to listen and take notes; often, especially just after diagnosis, patients are frightened, overwhelmed, and very ill, so having another person there to keep the details straight can be very helpful.

  • Keep track of your symptoms throughout the month, so that you can report them accurately at your next appointment; this will help the doctor to understand how your disease and treatment are progressing.

  • Be honest about your activities. If you have missed a few doses of your medications, if you have been enjoying a glass of wine with dinner, or if you haven't been exercising, answer your doctor's questions honestly. They will appreciate your openness and it will help them to advice you about treatment in an informed way.

  • Stay on top of the details-know when you will be needing prescriptions renewed, whether you need appointments to see other specialists for issues related to your arthritis, and when any diagnostic tests are scheduled for.

  • If you feel that your doctor has heard your concerns during appointments and responded in a way that helps you to live better with your disease, pass those thoughts on to him or her. Doctors appreciate hearing and knowing that they are helping their patients.

Working with your physiotherapist

A physiotherapist (also known as a PT) can be an important part of a well-rounded healthcare team. When choosing a physiotherapist, it is important to look for someone who has experience treating your type of arthritis, if possible. As well, it is important that you feel comfortable with your therapist, and that you relate well on a personal level.

A physiotherapist will examine your body, and assess things like joint range-of-motion, muscle strength, and swelling or instability in affected joints. A physiotherapist will also likely look at any diagnostic imaging-like x-rays-that you have had done, as well as results from any laboratory testing-for example, blood tests or joint aspirations. Finally, the therapist will want to hear from you about your symptoms, mobility, and changes in your body.

For a physiotherapy plan to work, the person with arthritis must believe that the plan has value, and that it has the potential to be helpful. A plan will only be successful if you:
  • Provide input: building a physiotherapy plan should be a give-and-take process. Your physiotherapist needs to hear about your goals-what you hope to achieve from treatment, and any questions of concerns you have about the plan.
  • Commit to your plan: your plan can only succeed if you are committed to the goals you have set out and the treatments your therapist has recommended.
  • Follow through: once you have agreed on the plan and committed to it, actually executing the plan is critical. While this might seem obvious, this is likely to be the most difficult part. This means attending scheduled visits, and completing any exercises your therapist prescribes for you to do at home.
  • Communicate honestly: your PT needs to know how you are feeling about your treatment-whether you are encouraged, discouraged, confused, worried-so that they can help, and adjust your treatment plan if necessary. Be honest about your adherence to the plan as well-if you miss a week of home exercises, be sure to tell your PT.

Working with your occupational therapist

Occupational therapists (or, OTs) deal with some of the most practical aspects of life with arthritis; generally, their role is teaching people strategies for continuing to live active, independent lives when dealing with the physical limitations and psychosocial issues arising from arthritis.

The issues an occupational therapist may be able to help with are very wide-ranging-really, any part of your life that your arthritis has made more difficult. The occupational therapy assessment typically involves an interview about your daily activities, and depending on the nature of the difficulties, a more detailed analysis of your ability to perform those activities as well as environmental barriers or supports available (at home or work). Occupational therapists often have great advice about issues ranging from self-care and personal hygiene to workplace adaptations and recreation.

Occupational therapists are problem-solvers; in addition to the many adaptive devices available on the market, many simple "do-it-yourself" strategies exist. As well, an occupational therapist may help you learn how to set up your daily routine, so that you engage in the most difficult or tiring activities at times in your day when you have the most energy.

Here are some ideas for getting the most from your occupational therapist:
  • Set goals with your occupational therapist. Your OT will work with you to maintain or restore your performance of the everyday tasks and activities that are part of the life roles you value most: like being a parent, spouse, friend, employee, student, volunteer - even an avid gardener or golfer!
  • Keep track of where you have difficulty. Keep a notebook and record the parts of your life that having arthritis has made most difficult. If you are able to provide your occupational therapist with concrete problems that you are having-for example, "I'm having trouble opening jars" or "lifting my daughter is really hard on my wrists"-your occupational therapist is likely to have more success providing some concrete solutions.
  • Be frank about what has become challenging. For many people, the loss of independence is one of the most difficult things about having arthritis. Simple, personal tasks that most of us take for granted, like bathing or even brushing teeth, can become difficult or impossible to perform independently. Do not be embarrassed. Your occupational therapist has certainly heard the same issues from many clients before you. Your occupational therapists are professionals, whose job it is to help you engage in the activities that are most important to you. Nothing you can say about what you are or are not able to do will shock your occupational therapist.
  • Evaluate your progress and discuss it with your OT. A little "trial-and-error" may be required, and a collaborative problem-solving process will help you achieve your goals.

FYI: general info/resources are available at