How to convince GP to refer to rheumatologist

Question  Dr. Matsumato,

I had a pustular rash on hands and feet, and began experiencing pain, stiffness and swelling in the larger joints of both hands and feet about 1.5 years ago. I had blood work and xrays done at that time and was told I had Osteoarthritis since everything was normal. I was prescribed salsalate which helps some. Since then I have had (along with hand and feet problems) lock jaw, swelling in my ankles, pain in knees and wrists, and now most worrisome, pain and stiffness in my neck and shoulders. I returned to the doctor and was given steroids and a muscle relaxer which was miraculous. I felt great until the steroids were gone.

I went back to the doctor a couple of weeks ago, and the lab work was repeated. Everything was normal again, but I insisted on a referral to a rheumatologist. He claims that my referral request was rejected due to the normal blood work.

What action should I take now? I am in pain, and worried. My activities have been limited a great deal by this condition. I used to be a distance runner and professional musician. I cannot pursue either of those interests any longer. In fact I find it hard to even take my daughter to the mall most days. I have absolutely no energy and it takes all I have to make it to work every day.
 
Answer  I can't make a diagnosis without seeing you, but your history sounds like you may have an inflammatory arthritis such as psoriatic arthritis. You describe ongoing symptoms and disability and thus I agree that you need to be seen by a rheumatologist for a definitive diagnosis and treatment plan. Your labwork can be normal and still have signficant problems. I would ask your doctor to appeal to your insurance company and call the insurance company youself to find out how this can be appealed.

All doctors are completely overwhelmed by the paperwork required by insurance companies to get anything done-- referrals, medications, x-rays. It is a tactic to harrass physicians to limit services to patients. So be kind but persistent with your doctor. Unfortunately, if this proves unsuccessful, the ultimate answer would be to seek a new GP.

Last update: 07:09 PM Tuesday, April 10, 2007

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Author:

Alan Matsumoto, M.D.

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