Q: I've read that there are many things people can do to help manage their arthritis, yet every time I talk to my doctor about my rheumatoid arthritis, he mentions little more than the next medication – or new dosage – he is going to prescribe for me. What are some of the self-help things I can do and how can I get my doctor to involve me more in my own care?
A: The concern that doctors don't encourage patient self-help is, unfortunately, a common one. The problem, in part, is that the medical system itself arose in an era when acute disease predominated. Doctors traditionally have been trained to treat acute illness, which has a clear cause and cure in most cases. The doctor diagnoses the problem, determines the cause and administers the treatment. Then, if all goes well, the disease responds with little or no effort on the part of the patient.
For chronic conditions like the many types of arthritis, for which there may be no cures, patient self-help managing the disease requires a continuing, cooperative relationship between the doctor and patient. In this relationship, you – the patient – are actually the main caregiver. This is a new concept for most doctors.
Certainly your doctor must make the diagnosis, recommend a course of medical treatment, monitor your response to treatment, and adjust that treatment accordingly. But it is you who must follow your doctor's prescription, day in and day out. You are also the one who must monitor your symptoms and call your doctor between visits if you have a problem that needs to be addressed or a drug dose that perhaps needs to be changed.
At office visits, you must honestly describe to your doctor how you are feeling and what you've been experiencing. Your personal accounts, along with lab tests and examination results, help your doctor make important treatment decisions.
Aside from medication-related issues, there is a lot more that you can and should do with the help and support of your physician. For one, you must maintain an overall healthy lifestyle. Proper nutrition and exercise are particularly important for people with arthritis.
If pain is a problem, as it is for the majority of people with arthritis, there are measures – other than medications – that can help you feel better. Exercise can help relieve pain, so can applying heat or cold to affected joints and using relaxation techniques.
Making your home as accessible as possible and using assistive devices – such as reachers to retrieve things from high shelves, or zipper pulls if your fingers are sore or no longer nimble – can relieve frustration, protect joints and help you remain independent.
Most importantly, you can learn more about your disease and its management. Just understanding your disease can help allay some of the anxiety you may be feeling. Learning about your disease and taking a more active role in managing it can give you an added sense of well-being and control.
Finally, there's one more thing you can do: Talk to your doctor about your concerns. Explain that you are interested in taking a role in your own care. Show your interest by bringing up medical issues you've seen in the news or by sharing articles from Arthritis Today or other magazines and newspapers. Ask your doctor for educational materials, schedules of exercise classes, support group information or referrals to a physical therapist or dietitian.
Just as there are doctors who are used to being the key players in their patients' health care, there are many patients who want – and expect – their doctors to assume the sole responsibility for disease management. If you haven't indicated otherwise, your doctor may assume you are one of them. Given the opportunity, most doctors are happy to encourage and improve patient self-help. And studies show that you'll be better off taking that self-help role.
Doyt L. Conn, MD, Rheumatologist