Making the most from your GP consultation

It can often take doctors some time to diagnose JIA.  This is because the illness usually comes on gradually over time, the symptoms of the illness vary a lot between different children and different ages of children and the signs of the illness when a child is examined are often difficult to see/pick up. 

Unfortunately, delays and the difficulties GPs face in making a diagnosis of JIA can understandably often lead to parents returning to their GP’s surgery, or visiting the hospital to see the consultant feeling confused, anxious and frustrated with the medical profession.

Initial visit

Paediatric practice is unusual because doctors ask about the symptoms from one person (the parent) about another person (your child). However, if children are old enough to explain they should be encouraged to answer the questions, with their parent’s help, because they can often provide meaningful clues that parents may not be aware of.

Making a successful diagnosis largely depends on asking detailed questions about your child’s illness and carrying out a thorough physical examination of your child. Only rarely does it depend on investigations such as blood tests or scans. Parents should expect the doctor to ask them lots of questions regarding their child’s joint problems, level of activity, eating habits, sleep patterns as well as questions about their child’s past illnesses, injuries, allergies, immunisations, development, education and so on.  Parents will also be asked about any medical conditions in their extended families as this can also help the doctor with his/her diagnosis of your child’s condition.

Tips for Parents

How can parents help the doctor?

  • Make a list, in date order of your child’s symptoms to take to the appointment as this can be enormously helpful for the doctor.
  • Take a photograph and/or a video of your child’s skin rash, joint swellings, difficulty while performing any activities like walking, running, going up or down the stairs, struggling with writing etc. on your smart phone or camera and bring this to the appointment.  
  • Talk to your child about going to see the doctor and tell them the doctor will want to examine them and explain to them what this means.  This will help to prepare your child for the examination and also help the doctor.
  • Bring any medicines to the appointment your child has been taking.
  • Dress your child for the appointment in such a way the doctor can examine all the joints, taking care the clothes do not hinder the movement of the shoulder and the hips during examination.  Loose shorts and vest/T-shirts are ideal for all boys and girls of any age, either to bring or wear under their regular clothing.
  • Let the doctor know if your child has sustained any injuries before the start of the examination.
  • Tell the doctor of any other investigations that are planned for your child with another doctor/speciality although, the diagnosis for JIA is usually made based on your child’s medical history, which is written in their medical notes, and your discussions with the doctor as well as an examination.
  • If you have a diary or can use the diary on your phone/iPad this helps for planning future appointments and investigations whilst you are with the doctor.
  • Don’t be afraid or embarrassed to take notes during the appointment about what the doctor tells you and contact details of the relevant health professionals.
  • Start a folder with all the relevant documents regarding your child filed in order.  This can help you to remember appointments and what happened when and who you saw.  It can also be a handy reference for the doctor and the other members of the health care team looking after your child because it provides a good continuity of care between the various health professionals.

After diagnosis

  • After your child has been diagnosed with JIA don’t be afraid to ask the doctor or another health professional on the team questions about what it all means, about the treatment plan and any worries you have. 
  • Your child will have regular hospital appointments to check their response to treatment, to examine all the joints and to ensure eye checks are being performed regularly.  For some children with JIA it is very important that they have regular eye examinations by an ophthalmologist to check for inflammation, and not just high street opticians because the optician does not have the necessary equipment (a slit lamp) or the expertise for this specialist test.
  • Follow-up visits with your child’s doctor will be similar to their initial appointment although you may not be asked so many questions again. During these follow-up appointments the doctor will want to know about your child’s JIA since their last visit and if there have been any changes.  Parents sometimes find it helpful to document any changes in symptoms or treatments or any concerns they may have in between appointments so they can discuss them at the next appointment. 

Things to remember

  • Don’t forget to take the “diary” of your child’s symptoms and details of any appointments your child has booked with other specialties when they see their doctor or clinical nurse specialist.
  • When searching for advice and information about your child’s condition on the internet remember, it’s very important to visit only websites of reputable organisations such as, JIA-at-NRAS, National Rheumatoid Arthritis Society (NRAS), British Society for Paediatric and Adolescent Rheumatology (BSPAR), Arthritis Care, Chronic Childrens’ Arthritis Association (CCAA), Scottish Network for Arthritis in Children (SNAC), Scottish Paediatric and Adolescent Rheumatology Network (SPARN), Arthritis Research UK (ARUK).
  • Similarly, teenagers need to be careful about which internet and social networking sites they visit, there are some sites which are very supportive such as Arthur's Place.

 

By Dr Satish Bangalore (Paediatrician)
Original article: 02/01/2015
Reviewed: N/A
Next review due: 02/01/2018