Most of us have struggled with this. Writing your questions down is great, and it can help you as well as the doc.
If you have a university research institute nearby, THAT is the place to go. I’m guessing that you will get a clearer picture than you have now. Forty minutes? A short trip for the benefit it may give you. It was a research institute consult which turned me and my disease around. Go for it.
I can see what you’re saying about what is and is not acceptable. The way it worked for me was to read, read, read. Mostly forums admittedly, but I ‘sift’ i.e. try to gauge which opinions are the most informed and consistent.
One thing I landed up being fairly certain about was that persistent swelling was a no-no. So my first long-term rheumy who managed to look at very swollen knees on otherwise rather boney legs and declare them ‘not swollen’ (the left one had been swollen for 2 years plus by then) did not inspire trust, confidence or respect. The fact that he was also a complete comedian (and not in a good way) really confirmed my decision to look elsewhere. The next rheumy agreed with me that the footballs on my knees constituted significant swelling and that I therefore needed biologics.
I would say that occasional swelling and and low-level fatigue may be more difficult for biologics to banish even when they’re working well for us. That’s the impression all the posts here & elsewhere have given me along with rheumatologists’ advice. But there’s quite a distance between that and not being able to function at all and I wonder whether you’re rheumy was (at best) being a bit flippant. If ‘things’ were clearly going downhill for some time I would expect my rheumy to re-evaluate the effectiveness of the biologic rather than to wait for me to collapse in a heap.
As for skin and eyes, well he isn’t a dermatologist or an ophthalmologist. But what would happen if you asked for a referral to dermatology or an eye specialist?
I think I might be able to put up with this doctor of yours, maybe, while keeping an eye on him! He might need a little help with the communication skills e.g. ‘are you really saying I’d stay on Humira right up to the point at which I couldn’t function at all? You big fat joker! You surely don’t mean that, come on!!’ Okay, you might want to tweak that a little.
In reality I guess no doctor is likely to have it all. The first rheumy I saw was a locum who diagnosed PsA in about 10 minutes, started me on pred and Mtx and told me to come back to have my knees aspirated. When I turned up the next day she saw me making poor progress down the corridor, yelled ‘Aren’t you better yet?’ Ran over and gave me a hug and a helping hand. I loved her. But oh my did she make a pig’s ear of draining my knees!
1 Like
Thanks Seenie!
A timely reminder of how assertive I can be 
(I usually think of myself as desperate), I’ve an appointment coming up soon!
The trick is to find whatever way you can - to get the result you deserve - be assertive, or record, like poo does, find a better Rheumy, or whatever works for you, because we all deserve good care.
1 Like
I think there is probably a short answer to the question in the title of the thread:
Q. How do you know if your doctor is good?
A. Your gut feeling.
And I say that because one doctor might be good for one person, and another might be good for someone else. We all have different needs - some of us want to know the details of what is going on in our bodies, whereas others would rather not know. Some of us would rather knock the PsA on its head no matter what side effects might occur from the drugs, but others are more worried about side effects. And so on.
So, he might be a great doctor, he might be the greatest mind in the world. But that doesn’t mean he or she is right for you. And, in the end, that’s what matters.
1 Like
True, Darinfan! I liked that first rheum, but I didn’t feel cared for or safe. My gut told me it was all wrong. My head said “She’s the rheumatologist, you’re not.” I should have gone with my gut.
1 Like
My gut feeling usually ends up being the most intelligent part of me. I take time to allow it be heard by me too.
The older I get, the more I trust my gut feelings.
1 Like
PREACH! 
Well, the gut is home to a second brain, after all.
1 Like
Hi, Everyone
I writing from Toronto, Canada. I have some issues with my rheumatism. She is only available one day a week, and I can never get a cancelation appointment for several months after the issue has occurred. I have been on metho, for 7 months, with no real releaf. I have had a an ankle fusion, due to Psa, and I still cannot stand or walk very far, without a lot of pain. Presently, I am torn, what advice can you offer. Feeling hopeless…
Sounds like you need to call the office and MAKE. A. STINK. And while you’re at it ask your GP to find you a referral to a new rheumatologist. Give a new person a try. Second opinions are important if you feel you’re not being heard or if you don’t feel enough is being done. Its a good way to get a touchstone on “reality”.
1 Like
Wondering which hospital you’re attending as Toronto has THE PsA clinic, attended by at least a couple of our members here. It’s the one with Dr Dafna Gladman at the helm … I guess glitches occur with any hospital, but if it is not the one you’re at, perhaps you could get a referral? As I understand it they are all for the most ‘aggressive’ treatment for moderate to severe PsA.
1 Like
Thank you, for the support. I am aware of Dr. Gald answer clinic at Toronto Western, not sure I am ready for the aggressive meds. I would like to just feel that I am doing more than just existing from one painful day to the next. I have attended a seminar last year, by Dr. Galdman and TWH. I found informitive, it might be a time for change.
I was wary of using that term without explanation, it can sound alarming. I was thinking biologics, as you probably realise, and as far as I know the word ‘aggressive’ tends to mean aggressive towards the disease rather than towards the patient.
In any case I doubt very much that any clinic would pressurise you to take meds you weren’t sure about. But the Toronto clinic might offer better care than you’re receiving right now.
belindakok,
I started off with a perfectly reasonable rhuematologist who at least did diagnose me, early and quickly. But I knew he didn’t have much interest in PsA. He also wasn’t very good at educating me about it all, indeed I found I was educating him.
So I asked eventually 9 months later for a 2nd opinion and got myself to a true PsA specialist, who was also interested in me. The difference was huge. I now feel safe and cared for. That makes such a lot of difference. That allows me to finally start appropriate medication too. And I want to do lots more too than exist from one painful day to the next too. But the only way I can see that happening is to get on the meds and get this disease at least somewhat controlled if possible. Feeling cared for, feeling safe, knowing a great team is on the other end of the phone for me, answering all of my silly questions is just so nice. I can’t tell you how nice. So get yourself to the best rhuemy team you can find and if you can access that one, I’d be there in a flash. It also means you’re being dealt with by people at the top of their game for this disease, surely that’s better? Best of luck.
Just wanted to thank you all for the input - I just requested my appointment at PennMedicine so that ball is rolling now!
3 Likes
I appreciate all the support. I am considering changing doctors, but change is hard. The thing is I have the confidence in my doctors abilities and trust her. But I just can not get the access to her, when I Need to. Still, unsure. Talking helps, making change easier.
1 Like