Find the Best Rheumatologist for You - How to Choose a Doctor to Treat Your Autoimmune Disorder

Joint problems have led your general practitioner to suspect rheumatoid arthritis, so you’re searching for a specialist. Or maybe you’re already seeing a specialist, but don’t think he or she is the best rheumatologist for your needs. Here’s how to find the right doctor, prepare for visits and get the most out of every appointment...

When Jodi McKee, an insurance company manager in Brooklyn, developed scleritis – inflammation of the white outer layer of the eye – her ophthalmologist suspected an autoimmune disorder and sent her to a rheumatologist. That doctor quickly diagnosed her with rheumatoid arthritis (RA). But soon McKee, 34, felt dissatisfied.

“I’d have to wait in the office for 45 minutes to see the doctor,” she says. “And when I called for a [medication] refill, I’d be on hold for 20 minutes. I never really felt they cared.”

After a year, McKee saw a second rheumatologist recommended by a friend with RA. But again, she was troubled: “For every appointment, I had to have a list of questions ready or the doctor was out the door in five minutes. It felt frantic.”

Joint problems caused by rheumatoid arthritis, an inflammatory autoimmune disorder that affects 1.5 million American adults, are worrisome enough. But if you have trouble finding the best rheumatologist to treat your pain and inflammation, the condition can feel overwhelming.

Here's how to get a rewarding doctor-patient relationship.
Find the best rheumatologist: Use your contacts.
Talk to people who know. Begin gathering possible doctor names by talking to your primary care physician or an orthopedic surgeon who's familiar with joint problems.

“Taking the recommendation of someone you trust can help,” says Harry Fischer, M.D., chief of the division of Rheumatology at Beth Israel Medical Center in New York City.

Ask family members and friends too, McKee says.

“If you know other people with an autoimmune disorder, [ask] if they like their doctor,” she advises.

You can also get suggestions from the American College of Rheumatology’s website, which lists its members by city and state.

Look for the best and brightest. “The guiding principle for choosing any doctor is brains,” says Steven Z. Kussin, M.D., author of Doctor, Your Patient Will See You Now (Rowman & Littlefield Publishers, 2011) and founder of a medical advocacy practice in Utica, New York.

“Patients can work to elicit better communication and empathy from a doctor, but they can’t enhance [intelligence],” he adds.
“See whether the doctor went to a top medical school and a world-class training facility,” Kussin says. If you don’t know which schools are tops, view the rankings at U.S. News and World Report.

Check credentials. Find out if the rheumatologist is board-certified.

“That means he’s completed a fellowship in rheumatology and passed the board exam,” Fischer says.

The American Board of Medical Specialties has a free searchable database to find certified doctors. (you have to register before you can use it.)

Weigh experience. How many years of practice has the rheumatologist had?

More is generally better, says Nathan Wei, M.D., director of the Arthritis Treatment Center in Frederick, Md. According to Wei, if it’s less than 10, you should look elsewhere.

Still, a more recently trained doctor might be more up-to-date on the latest treatments, notes Fischer – so it’s really up to you.

Ask if they do clinical research: Wei believes the best rheumatologist does and should have published at least 10 research papers.

On the other hand, doctors who don’t split their time between seeing patients and research may be more accessible, Fischer says.
Investigate office mechanics.
“Check out the [doctor’s] website,” Wei advises. “No website, or a poor one? Look elsewhere.” The site should have a mission statement, the doctor’s training history and photo, and a list of interests, Kussin says. These days, “the website’s quality correlates with the quality of the doctor," he says.

Office staff matters. If they’re inefficient or uncaring, those attitudes probably run throughout the practice.

“If the phone’s answered by a gum-chewing dimwit, what do you think you’re going to get [from the doctor]?” Wei asks.

The doctor McKee finally found has only one assistant who knows her and her case. That has made getting refills, dealing with bills and making appointments a lot easier.

But you should also be realistic, Fischer cautions – in some areas, you may have to wait three or four weeks for an appointment.

“There’s a shortage of rheumatologists in many parts of the country, so wait times for appointments can be longer than in other subspecialties,” he says.

“But if you have an emergency, you should be seen the same day,” Kussin adds.

Find the best rheumatologist: Prepare for the appointment.
Summarize your situation. Jot down a history of your autoimmune disorder and health in general. List the medications and supplements you take, as well as any allergies you have. For a personal health record template, go to www.certificationmatters.org.

“Write down symptoms too – what’s new and not,” Kussin says.
Know your priorities. “Write down your expectations and goals for visits in a short note the doctor can read,” Kussin says.

Visits often go awry because patients wait until the last minute to bring up embarrassing topics or voice real concerns, like how RA is affecting work and family, Kussin says.

Do your homework. Learn as much as you can about rheumatoid arthritis and potential treatments by going to well-recognized sites such as American College of Rheumatology (ACR) and the Arthritis Foundation, Fischer says. Also, visit our new Rheumatoid Arthritis Health Center.

It helps doctors “when patients come in with specific questions and are familiar with the disease and the types of medications,” he says.

Join ACR for $80 a year, which makes you eligible for breaking news about rheumatoid arthritis and treatments, Kussin advises. To join, your doctor must sign your application.

Other (free!) resources: MedPage Today is a medical news search that tells you the latest about RA; the Rheumatologist is a news digest from the ACR; and UpToDate) is an information-search site provided by several medical associations.

Find the best rheumatologist: Guide the appointment.
Don’t rely on your memory. Taking someone with you to appointments is “a good idea if you think you may not get [all the information you need] out of visits,” Fischer says. “It can make it easier so that you don’t have to repeat all the information at home.”
Ask for copies of results and consultation notes so you can review them at leisure, especially if you’re deliberating treatment options.

Arrive with an open mind. “What works for your friend or on TV may not be right for you,” Fischer says. “Rely on the physician to examine your joints, listen and look at blood work."

That may mean they may come to a different conclusion than what you expect, he says.

"There are [many] treatment options, and not every one is appropriate for each patient.”

Ask about complementary and alternative treatments. “Complementary medicine has its role, particularly in musculoskeletal diseases,” Kussin says.

Again, ask your doctor after you’ve armed yourself with information. Kussin recommends the materials at ACR and the National Center for Complementary and Alternative Medicine.

“Patients need to be cautious,” Fischer says. “Claims about complementary treatments are not [always] supported.”

Trust your gut. No matter how smart, credentialed and experienced a doctor is, if they don’t meet your needs, they’re not the best rheumatologist for you.
“It’s hard before you meet someone to know if the relationship will work,” Fischer says. “Meet the doctor and find out if they're someone you can talk with, and if they're available to answer questions.”

“Ask yourself what your preferences are,” suggests McKee, who found that what worked for her friends didn’t always work for her.

For example, “do you like to prepare a list of questions or do you want to have a more organic conversation with a doctor who will take the time?” she asks.

Find the best rheumatologist: Know when to switch doctors.
Compare what you want with your experience. “It’s time to leave if you’re not getting what you like from the doctor,” Fischer says.

One caveat: Even the best rheumatologist can take a while to find the right treatment for you.

“No doctor can determine the ideal therapy for each RA patient,” Fischer says. “Often, things are tried and don’t help. That’s the nature of the condition, not a reason to switch doctors.”

Consider convenience. This shouldn’t be your sole criteria for selecting a doctor. But if you must wait weeks for appointments or spend long periods in the waiting room, the inconvenience may prevent you from getting the best care.
“If a doctor is consistently late, it may not be worth your time to wait there,” McKee says.

“Convenience is important,” agrees Kussin. For example, if your medication has to be given intravenously – often the case with RA drugs – and your doctor requires you to go to the hospital for the infusions instead of doing them in-office, that will require more time and money from you.

“You can find smart rheumatologists who also give infusions,” Kussin says.

Jodi McKee says her search for the best rheumatologist ended well.

She tried a doctor who was recommended by another friend with an autoimmune disorder.

“She’s terrific,” McKee says. “She really takes the time to listen and has a thoughtful, caring bedside manner. I feel very well taken care of.”

For more information, visit our Rheumatoid Arthritis Health Center .

How Much Do You Know About the Types of Arthritis?
About 46 million American adults – nearly one in five – suffer from some type of arthritis. It’s estimated that number will rise to 67 million by 2030. Do you or someone close to you have arthritis?