Why does Rheumy do this

pal

Hi All
I saw my Rheumatologist again (at last! - hard to get in there - long story!) last week.
I was initially prescribed Methotrexate etc last year but was intolerant to the drug.
Same thing then happened with Sulfasalazine. This time she has talked about me trying Leflunomide. But what I don't understand is this : Each time she talks of a new med, she gives me a leaflet about it and says, "Read that and see what you think", and gives me a note for my GP to prescribe if I want to try it. I thought they would either prescribe it or not, not ask me to think about it and then decide myself.
Also, Leflunomide can raise Blood Pressure, and I am already on meds for high BP.
Have been seeing GP for a while to find an add-on med beacuse BP staying high anyway. Am seeing my GP this Tues for advice.
But my Question is this : Is it normal for Consultants to ask you what you think first about taking new meds? Does this make sense? Thanks for reading this!
Best wishes all. Pal

Colin1

Hi Pal yes i think this is normal for the Rheumy to ask what you think . You should always write down any problems you have or questions you have so that when he or say says have you thought about this or that you can ask does it interact with meds or problems you already have. Offten when you read about these things they seem worse than they are, I always find that when you move on to other meds or more serious meds reading the booklets and leaflets is scary and with the Anti TNFs is really scary.
Take care Pal catch you soon
Colin

frogmorton

Hi Pal

They do seem to do more and more of this these days, but am sure your Gp will be happy to advise. Now you have read the info you know what to ask him too.

Good luck

Toni xxx

deedeeitsme

Hi Pal....I would like to think that they all do this. I think just giving you drugs and saying get on with it is bad practise. Forewarned is forarmed as they say and you can keep an eye out for side effects as your rheumy or gp cannot monitor you 24/7. I like to be informed about what I'm taking. Hope the treatment works well for you but please ask your gp about any concerns you have about your meds, that's what they're there for. x Dee x

valval

mine usually say did you want to try ?????? that we talked about i am sat there thinking no we did not, but say yes that sounds like a good idea lol this has happened twice but because of this place know the ins and outs of most of the meds he likely to try so does not bother me but they like you to be more incontrol of your own treatment. but always ask gp if at all worried val

applerose

Mine always gives me a leaflet to read first and he knows I always research online before I decide. I like to know as much as possible before I start any new meds.

stickywicket

This does seem to be coming in more and more. I guess - and it's only a guess - it's because, on reading the leaflet, the patient may realise, as you have done with your BP, that they have other conditions which might cause a problem and it enables the patient to then discuss these with their GP before starting the new meds. I've had RA for 50 years. I'm on my 3rd rheumatologist (The other 2 retired) and, with a file as thick as War & Peace, I don't expect her to remember - or even know about - every non-arthritic medical problem I've had in that time. I think this is simply a safer route.

jillyb1

Wish mine was more amenable in this way ; he tells me what to do and expects obedience without question . When I ask about side effects etc , I'm told , " why do you ask ? I have training " . Reply of course is always , " yes , but it's my body and I'm trained in looking after it ! " Jillyb

Nixxy

Hi,

This is certainly becoming common practice with most hospital trusts no longer issuing prescriptions for outpatients. The cynic in me tells me this is more about cost than good practice as there was a growing pool of evidence that GP prescribing costs the NHS less.

There is also a good practice element to it and you need to make this work for you. Your GP will know you better and have a better understanding of your holistic medical needs/presentations. As the issuer of the prescription the monitoring and management also fall to your GP in the first instance, as your GP is normally more accessible that your rheumy this is also positive. The time lag between initial discussion with your rheumy and then seeing your GP does give you time to consider/research the suggested option which again can be postive.

However, there may be some down sides to bear in mind. Your GP is not a rheumy, therefore does not have the expert working knowledge of the rheumy. Mine regularly has to look drugs up and research the monitoring requirements. This means you have to trust them to research and implement safe monitoring so do discuss this with them. Without the expert knowledge of the drugs they will not also automatically recognise potential interaction issues, GPs are not pharmacists! They are also not always best placed to answer questions about your arthritis and treatment when you have considered your options and can't often prescribe alternatives should you decide it's not for you.

Also, some GPs just won't prescribe some drugs. Mine won't prescribe Methotrexate based on another practitioners assessment and won't lead in the monitoring, this sounds like a bad GP but I really felt they were working in my best interests by insisting that a specialist condition requires specialist prescribing and specialist monitoring (they were happy to do bloods etc just not make all the judgement calls). This has meant I've been batted back and forth between GP and rheumy for months with a detrimental effect on my health. I made a formal complaint against my rheumy for just dumping me on my GP and have changed hospitals. So glad I did, I'm getting much better care now which is co-ordinated and about me not shortcuts and savings!

Good luck everyone and never be afraid to question!

suzygirl

My rheumy does this and I think it is good practice. They are serious meds with serious side efects and we are going to be on them for a loong time. It gives us chance to think about and see if it will suit us.

My gp is always helpful.

Starburst

I wrote a really long reply that got deleted, grrr!

Basically, I said that I think it can be very empowering to make your own choices. However, I appreciate that it can be quite frazzling for some people and overwhelming. I don't think rheumatologists would be offended if people asked for more guidance, I just think they're trying to advocate for more patient involvement.

I'm sorry you're having so much trouble with settling on medication.

pal

Hi everyone. Thanks for replies. Plenty to think about!
Take care
Pal