Q: How do I talk to my specialist about getting scans or x-rays to establish exactly how much damage has been done?
A: Good question. Taking this question on face vale the answer is easy- just ask! But I think there may be more than meets the eye to this question.
The question perhaps lacks context, for example, is this question being ask because the person felt their symptoms were being dismissed or ignored? That is, when they did ask, the specialist said no to more imagery. Or is it that this person simply isn’t sure on how to start a conversation with their doctor? Also, it’s clear the broader context of the question is pertaining to arthritis but there are many different types of arthritis and different guidelines and recommendations to how each may be diagnosed, managed, and if/when imagery is needed. So, it may not matter how you ask, your specialist may or may not endorse imagery based on many factors unbeknownst to you.
With the above in mind, let’s look at some ways you can ask your specialist (or GP) for something – firstly in the context of genuinely wanting to know how you talk to/ask questions to your doctor, then secondly, if you are feeling like your concerns or symptoms are being dismissed. Then I’d like to switch the point of view and provide some insight from the specialists’ perspective.
How to talk to/ask your specialist about getting imagery
If you are feeling concerned about the impact your arthritis is having on your joints e.g., symptoms change or worsen, then voice this to your specialist. Make sure you keep notes of how and when these changes occurred, including changes in mood, daily activities, medications etc. This information may help your specialist to understand the situation better. After you have voiced your concerns, ask what, if anything, can or should be done about these changes/new symptoms, are they normal, do they need to be monitored? If the doctor hasn’t suggested imagery, and you feel like it might be a good idea, then ask the doctor to consider this option. If he/she does not feel imagery necessary, then be sure be sure to ask why – there may be a valid reason for this decision. For example, you may feel a CT or MRI should be prescribed. The doctor may say no because these types of scans may not be the right type of scan, perhaps just an x-ray will suffice, and/or it may not be worth the level of radiation exposure for what typically is the natural progression of the disease (i.e., further damage is expected).
If you feel uncomfortable or lack the confidence in asking your doctor these things, here are few options that may help.
- Bring a support: a friend or family member to help advocate for you, ask questions for you, or help you understand. They may give you the confidence to assert yourself.
- Know before you go: The more prepared you are more you’ll get out of the session. Make a list of things you’d like to talk about and ask.
- Prioritize: Yes, come prepared with questions, but you may have a lot to cover in a short time. Prioritize your top concerns, so you get your most pressing questions answered first.
- It’s OK to speak up if you disagree: Your doctor prioritizes your health and will welcome your concerns, so your treatment is tailored to you. Expect respect, and if you don’t get it, you have the right to consider another opinion. A good doctor will support your right to exercise autonomy and welcome open dialogue.
- Take your time: You also shouldn’t feel rushed. If you don’t understand an answer, don’t be afraid to ask for clarification.
But what if you’re feeling dismissed or ignored?
Here are some other options to consider
- If your symptoms are ignored, ask, “What might this be?” And then ask, “What do I do if these symptoms get worse?”, also “when is the appropriate time for scans, if not now?”. These types of questions help the doctor to stop and consider the options.
- If you feel your specialist or primary care doctor doesn’t take your symptoms seriously, ask for a referral to a/another specialist or go to a different practice for a second opinion. A fresh set of eyes can be extremely helpful.
- Learn about the types of screenings that should be performed routinely on someone with your condition so that if the doctor doesn’t address certain aspects of the check up (e.g.., scans), you ask why and reference the typical screening or treatment guideline/protocol.
The Doctors Perspective
In the context of arthritis, your doctor or specialist has may things to consider when you ask them for imagery. For example, if it’s osteoarthritis (OA), an x-ray isn’t needed to confirm OA; a diagnosis can be made simply from a thorough a health/medical history interview, asking some specific questions and possible observations. Simple x-ray testing may be used to help exclude other causes of pain in a joint or atypical OA presentation – but please note, there is not always a causal relationship between imagery outcome and pain, and damage and pain.
A doctor still may request imagery, independent of an OA diagnosis, to compare changes over time, and here lies your argument for asking your doctor for an x-ray (or whichever scan). However, your doctor will always assess this case by case. That is, what’s the reason for the scan? Have your symptoms changed only slightly or have they severely declined and the impact to your life has been severe.
Just know your specialist is weighing many things in their head when they asked such a question. If it’s an outcome you don’t like or disagree with, make sure to ask them to explain how they arrived at that decision.
Author: Kat Keane
Date: June 2022
I hope this Ask Kat has been helpful. Please contact me if you’d like further clarification or information on anything mentioned above.