Telephone appointments with a Rheumatologist?

[YorkieBard]

I have just received a Rheumatologist's appointment letter & was surprised to see that it will be conducted over the phone.

I just wondered how common this is.

I am still awaiting a definitive diagnosis having been told in January, March & June that I have seronegative inflammatory arthritis.

The Rheumatologist is well aware of my widespread joint pain, swelling & stiffness from previous examinations.

MTX & LEF don't work for me.

During my last appointment in June he gave me an injection of 120mg of Depo-Medrone into my backside & ordered a complete spine MRI (querying axial spondyloarthropathy), more bloods & an ultrasound of all my finger joints.

He also gave me 3 information leaflets on Sulfasalazine, Adalimumab & Etanercept & said that we would discuss the pros & cons of each at my next appointment.

He has the edge on me as he can obviously see my latest test results & I'm in the dark.

Has anyone any experience of switching to telephone consultations at this point in the journey?

[helenlw7]

I was finally diagnosed with RA in 2004, and have had f2f consultations every 3-6 months since then. Occasionally I’ve emailed my consultants to say I need a steroid injection, and she’s rung me then seen me the following day to give the injection.

[YorkieBard in reply to helenlw7]

Thanks for responding

[Fruitandnutcase]

I got a communication from the department a while ago asking about that. I said I didn’t mind whether it was f2f or in person or if I was left to contact them when I felt I needed to see them.

That may have been foolish of me because I haven't heard anything from them since - even though I was scheduled to be seen a year after my last f2f ( I had that after I contacted them and asked) and that was in 2021!

[Neonkittie17 in reply to Fruitandnutcase]

I’d say I’d like a ftf for you to see my joints. I thought they had to examine them in order to continue the meds? I was told that some years ago though.

[Fruitandnutcase in reply to Neonkittie17]

Since I started with my rheumatologist I’ve on.y had the blood test my diagnosing doctor did before I went to the clinic - he did a fast track referral around 2014. Since then I have had one set of bloods and one hand X-ray the doctor who did them said at the appointment the following year that I was in remission and talked about stopping my hydroxy - he said the same to the surgery dispenser who wasn’t impressed either.

In 2021 when I was last seen face to face I asked if I should stop the hydroxy - I’d been on it for a long time by then and the rheumy I spoke to said ‘ oh no’ so I’m still on it

[Cat-E in reply to Fruitandnutcase]

Don't you have bloods every 3 months to check liver function etc? I'm on mtx but assumed it was the same with other meds 🫤

[Fruitandnutcase in reply to Cat-E]

No, I get a ‘birthday treat’ medical every year during my birthday week because of my age, I’m not sure what it checks apart from cholesterol and HbA1c. I think mtx might be different to hydroxy.

[Neonkittie17 in reply to Fruitandnutcase]

I thought even on the non biologic meds you had to have a blood test to enable you to get a script approved by rheumatology to get your meds from their pharmacy of your GP. Am I reading this correctly that you’ve only had one blood test on hydroxy since 2014?

[Fruitandnutcase in reply to Neonkittie17]

You are indeed. My GP did blood tests way back when he referred me and since then I have had had one set of hand X-rays and one set of blood tests done by rheumatology! I see my optician every year and have my own OCT scans done to make sure the hydroxy is not damaging my eyes.

Considering last time I was weighed with all of my clothes on - think of the difference between summer and winter clothes so it’s not exactly accurate - and my height was measured with my shoes on, same thing with accuracy.

So between the infrequency of appointments, the fact I’ve never been told about rheumatology nurses and all the rest of I’m not exactly over impressed with my rheumatology dept. I’m sure if I emailed the dept secretary I would eventually get an appointment like I did the last time.

I find it really interesting to read about the experiences of other people.

[YorkieBard in reply to Neonkittie17]

That's the thing - I'm not on meds right now

[Neonkittie17 in reply to YorkieBard]

Sorry, it wasn’t apparent to me on your post. Couldn’t tell for certain when you put … MTX and LEF don’t work for me .. if you had stopped them or being told to continue until a decision re which of those meds next been made. Anyhow, hope it’s soon a more definite plan for you and good luck.

[YorkieBard in reply to Fruitandnutcase]

Oh heck but thanks for responding

[Runrig01]

Snce covid, my rheumatologist occasionally arranged a telephone follow up. All health professionals seem to now do phone consultations. Very common with gps. If during the conversation he feels he needs to see you, they will arrange a prompt F2F.

[YorkieBard in reply to Runrig01]

Thanks for responding - I'll keep fingers crossed

[welsh12]

The nurse does telephone consultations not my rheumatologist

[Neonkittie17]

I’d have thought they’d have wanted a ftf to examine your joints more regularly given you’re not fully diagnosed as such. I prefer a phone appt since the height of the pandemic/lockdowns and glad these are continued to be offered, but I am to attend and do every year since spring 2022 for a full exam of my joints and can change any of my phone appts to ftf as I want but my RA is under control. Can you ask for a ftf for next time?

[YorkieBard in reply to Neonkittie17]

Will do

[Soundofmusic52]

I think that the way they are going now telephone appointment s unless you are unwell you get to see the doctor.

[YorkieBard in reply to Soundofmusic52]

Thanks for responding

[virtualreality]

The majority of my follow up appointments with rheumatology have been by telephone, after three face to face appointments around initial diagnosis and starting treatment. I think it's quite common. Telephone appointments are generally with the nursing team or pharmacist rather than a consultant, but I think I've had one telephone appointment with my consultant.

Although it sounds like you still have active disease, it may be that they feel they have a good sense of what's happening from your previous examinations and the additional testing / scans that have been run. If they need to see you, they will offer a face to face appointment afterwards I'm sure.

Don't worry about your diagnosis still being seronegative inflammatory arthritis at this stage - sometimes it just can't be clearer than that in the early phase because there is symptom overlap between different forms (I was initially diagnosed with RA then it was changed to inflammatory arthritis for 6 months or so too, until it was confirmed as RA). The treatment options are essentially the same so it won't slow things down for you. I hope your appointment's helpful and you find a treatment combination that's more effective for you very soon, fingers crossed.

[YorkieBard in reply to virtualreality]

You've put my mind at rest! I was thinking about him knowing about the severity of my symptoms as being the reason for a telephone consultation. F to F I would be examined again & he would say - yes, just as bad. On the phone he will ask - how's things & I'll say same old, same old.

[virtualreality in reply to YorkieBard]

Oh good, I'm glad! Hopefully the call will be a useful conversation and move the treatment process forward for you. It sounds like there are some important decisions to be made about the medication options you've been offered, and with any luck, whichever one you go for, it'll get your symptoms under control at last.

[Otto11]

Hi personally I would call them as I feel at this early stage you should be given a ftf appointment at least until things are fully diagnosed & a plan in place Especially as you are potentially about to start on Biologics. I find it quite odd. Do you have a Rheumy Nurse you could contact?

I was initially diagnosed as Sero negative inflammatory arthritis either RA or Psoriatic Arthritis. The treatment is the same. However my Rheumatoid Factor changed to positive about 7 years later I was diagnosed in 1999 & have always had ftf appointments but things are changing & I think it’s becoming the norm for a lot of departments. I sometimes see a registrar who then goes to run it past the consultant who is generally with another patient so you wait about 15/20 mins then both the consultant & registrar come to discuss next step/future plan. All a bit time wasting in my mind but that’s the way it’s done. We no longer seem to have nurse appointments which I had in the old days every other appointment was with the nurse. I think they are short of nurses now.

Definitely give them a call you have nothing to loose x

[YorkieBard in reply to Otto11]

Thanks for responding, I did have a nurse appointment booked when on MTX - but it was cancelled when I was taken off it. Ditto with LEF.

[Otto11 in reply to YorkieBard]

Due to the fact you may be starting Biologics I would have expected a ftf but hospitals vary a lot. Good luck.

[pammi2]

why are you waiting s long, demand a face to face

[YorkieBard in reply to pammi2]

Thanks for responding

[Green230461]

my last appointment was by phone. I made a list of what I wanted to say and made sure I got it all in! The results was a face to face meeting !

[YorkieBard in reply to Green230461]

Thanks for responding - I've got a list. It's a long list!

[Lester23]

Agree with Green230461 , I was in the exact same position, made a list of things to discuss and I now have a f2f appointment next week. I was told that the phone appointments will become more regular once your symptoms are under control!

[YorkieBard in reply to Lester23]

Thanks - I've got a list ready