12 February 2020
Treating arthritis with a holistic mindset
A holistic approach for treating arthritis is an ideal that doctors and patients share. Yet achieving this in practice can be challenging for both parties.
What sorts of treatment options would you discuss in a typical appointment with an arthritis patient?
Obviously, it depends on the circumstances. Medical treatments such as NSAIDs, DMARDs, and analgesics are probably included in most conversations. However, do you also discuss non-medical options as part of a holistic approach to treating your patient? Is this something you actively strive to achieve?
There is no black-and-white response to this as we all have different expectations regarding what happens during an appointment. Often, there isn’t enough time to talk about anything but the most pressing issues in any case.
THE BURDEN FROM A PATIENT’S VIEWPOINT
The members of the CreakyJoints Australia Patient Council all live with various forms of arthritis.
Most of us have had times when our doctors have judged our overall wellbeing on the results of our tests and scans alone. Yet, we are far more than just numbers and images. These may appear fine, but arthritis could still be having a negative impact on our lives.
It is important to remember to look beyond the physical effects of arthritis and see how it can affect us on emotional, social, spiritual, and intellectual levels too.
- The young mum you see might be devastated that she can’t play with her children on the floor and she might hold a deep fear of them inheriting her condition.
The next patient might be worried about keeping their job as fatigue could be causing them to make mistakes or become less productive.
Medications might be working well for the next lady, but the side-effect of hair loss might be greatly affecting her self-esteem.
- Another patient might be well aware that they need to lose weight, however, they might not know where to get help or perhaps they have difficulty accessing appropriate services.
Of course, doctors alone can’t help us with all our issues. We’d just like you to watch out for them and to consider suggesting other forms of care, such as physiotherapy or dietetics, when appropriate.
RESPECT THE PREFERENCES OF YOUR PATIENTS
Our members have mixed opinions about the role of doctors in managing our overall lifestyle and wellbeing. No doubt you will see a similar range of opinions among your own patients. Therefore, individual preferences and personality types need to be taken into account before suggesting any non-medical treatments.
Here are some of the thoughts our members shared on the subject.
Alice would like her doctors to see mental wellbeing and general health as important aspects to treat alongside her pain and inflammation levels.
“Something huge I think is missing is an automatic referral for anyone diagnosed with a chronic pain condition to get access to mental healthcare. For example, having a professional explain the grief you might feel for the loss of your ‘old life’ can make a big difference to how you cope with the changes in your lifestyle. It can also help you feel more comfortable raising mental health issues with your rheumatologist in the future.”
Naomi feels it is a two-way street.
“Doctors need to be more confident about discussing the importance of things like diet and exercise and patients need to be willing to accept that just pills won’t cure everything.”
Shannyn would prefer her doctors didn’t offer unsolicited advice about her overall health.
“I find it condescending. I feel if my specialists know me then they understand if I need advice I will ask for it.”
THREE WAYS TO TAKE A HOLISTIC APPROACH
The CJA Patient Council members suggest several ways doctors can determine when and how to discuss holistic care options with patients. It might not always be relevant at each appointment, however it might help to have some strategies in place to help uncover the full extent of their patients’ needs.
Ask at the start of the appointment
When your patient walks in, ask them about how their arthritis has affected their daily life since their last visit and what is the most important thing they would like to discuss. This may seem obvious, but it is sometimes overlooked.
For example, their blood tests might show that their inflammation levels are high, but they might be more concerned about how their pain has affected their family life. This might be a good time to ask if they would like to see an occupational therapist or a counsellor.
Consider asking before the appointment
Starting that conversation might be tricky, so our Patient Council members suggested using some form of pre-appointment survey.
Alice suggested this include questions about mental health, family and friend relationships, social life, and so on. This might give a better picture of how the person is really doing and what their needs are rather than only asking about the pain or stiffness levels they feel.
Shannyn suggested that online appointment bookings include a short questionnaire with questions like: “What can we help you with today? Would you like to discuss other strategies for managing your condition or would you just like to address a particular issue?”
Involve a practice nurse
If your clinic has a practice nurse available, create opportunities for your patients to talk to them about their overall health and wellbeing.
Nurses often have more time to listen to the patient’s concerns and to get to know them better. They may also provide general education about conditions, treatment options, and ways to self-manage arthritis. Patients can then decide if they would like to talk about more personal concerns with you during their appointment.
If you find it difficult or inappropriate to talk about non-medical care with your patient, we suggest you provide all your patients with lists of reliable resources and of other types of health professionals they can turn to as needed.
Rosemary Ainley wrote this article on behalf of the CreakyJoints Australia team. CreakyJoints Australia would like to thank Rheumatology Republic for this opportunity to share the patient voice within the Australian rheumatology community.