General Practitioners and Family Doctors

• When these doctors know you well, they often know best how to care for your arthritis. It can work effectively with rheumatologists to take over your continuing care, even if you require specialized treatments. If you have a good relationship with a non-specialist who cares for 'the whole you,' consider yourself truly fortunate. 'My GP has known me and my medical history for thirty-four years,' wrote a forty-one-year-old homemaker from New York. 'He sent me to a rheumatologist, and I went for the tests, but I didn't think that doctor was taking my other ailments into consideration. I have diabetes, glaucoma, anemia, and asthma. So I'm sticking with my GP. He read the rheumatologist's report, and prescribed medications and treatments that fit me, the total person, in terms of what I can afford, what I can manage with my other conditions, my lifestyle, and my emotional needs.'

Many of our participants enjoyed the best of both practition­ers. Having seen a rheumatologist one or more times for an expert assessment of their state, they went regularly to their family doctor for medical treatment — such as periodic gold injections, if necessary — and moral support. Arthritis, after all, is a chronic condition that waxes and wanes. There are times that it demands the ultimate from modern medicine, whether in the form of a bold drug combination, a high-tech diagnostic proced­ure, or a feat of surgical derring-do. There are also times when nothing is more important than the sympathetic ear of a doctor who knows you well.

General practitioners or family doctors often work very effec­tively with the specialists their patients have consulted. The rheumatologist, who is too far away or too busy to take you on as a patient, may be only too happy to suggest a plan of action for your regular doctor to pursue with you. 'My family doctor always treats me when I have a bad flare-up,' said a plant engineer from Iowa, 'since the rheumatologist is at the university, quite a ways away from here.'

As the ratings from our US and UK survey participants show, general practitioners and family doctors are reasonably effective in providing temporary to long-term relief.


Outcome of treatment: Dramatic long-term relief Moderate long-term relief Temporary relief No relief (ineffective) Made participant feel worse

Many of the benefits offered by GPs seem due pardy to the long-standing nature of the doctor-patient relationship in many cases, and partly to plain old-fashioned good appropriate care. 'My family doctor has treated me from the beginning, and I credit him for my not being laid up permanently at this stage of my life,' wrote a fifty-four-year-old Pennsylvania salesman who has had rheumatoid arthritis since age thirty-two. 'I have been on gold for many years, plus anti-inflammatory drugs, exercise, good nutrition, and vitamins and minerals.' Other survey partici­pants raved about the practical advice they got from their family ^ipor, or the diet that launched their successful weight loss efforts.

A fifty-three-year-old office manager from California told this story: When I first went to a rheumatologist, he gave me no relief, but just kept saying, "Wait and see." I also saw a chiroprac­tor, a physical therapist, and a Yoga instructor, who were helpful so long as I wasn't in intense pain. My family doctor is the only one who started me on various anti-inflammatory drugs, and we experimented until I found the right combinations. He also had me using splints to rest my hands, and when I could no longer walk; I had wonderful results from arthroscopic surgery done on both knees by an orthopedic surgeon he recommended.'

However participants who were pleased with their general practitioners or family doctors made comments such as the following: 'Most GPs just don't have knowledge about arthritis,' said a banker from New Hampshire. They really don't seem to care about how one feels fighting stiffness, pain, and the inability to get around and do things.'

At their worst, general and family practitioners may prescribe the wrong drugs. 'My regular doctor,' noted a beautician from Alaska, 'was the one who just gave me codeine. I kept telling him that there must be a better answer, and he said that was all he could do. That's-when I decided to go to an orthopedic surgeon — someone who knew about joints and could tell me what to do for my problem without turning me into a drug addict.' The orthopedist switched her from painkillers to anti-inflammatory agents, gave her exercises to do, and taught her how to combine ice and heat for her knee pain.