Specialists and you

This is the third in our series exploring the different groups of health professionals and therapists who’ll help you live well with a musculoskeletal condition.

Managing a chronic musculoskeletal condition – or multiple conditions – can be complicated. To help you get the best health outcomes and maintain (or improve) your quality of life, you’ll probably see a variety of different health professionals and therapists.

Who you see and how often will depend on your condition/s, symptoms and how they affect your life.

What is a specialist in healthcare?

A specialist is exactly what it sounds like. A person – in this case, a medical doctor – who has undergone additional training to become a ‘specialist’ or an expert in a specific area of medicine.

Specialists work in clinics and in hospitals, both in the private and public health systems. To see a specialist, you’ll need a letter of referral from your general practitioner (GP) or another specialist doctor.

As far as musculoskeletal conditions go, the most common specialist that people will see is a rheumatologist. But many other specialists help people manage their condition. Let’s explore each of them.

• Rheumatologists diagnose and treat arthritis and other musculoskeletal conditions as well as some autoimmune conditions, particularly those that affect the musculoskeletal system. Paediatric rheumatologists treat musculoskeletal conditions in children and adolescents.
• Cardiologists diagnose and treat conditions that affect the heart and blood vessels. These conditions include high blood pressure, angina and coronary heart disease. People living with musculoskeletal conditions may be at increased risk of developing heart disease and may need to see a cardiologist for this.
• Dermatologists diagnose and treat skin conditions. People living with conditions such as psoriatic arthritis, scleroderma, lupus and rheumatoid arthritis may be referred to a dermatologist if their condition affects their skin, nails and/or hair.
• Endocrinologists diagnose and treat conditions that affect the endocrine system. The endocrine system is made up of glands that create and release the hormones in your body. Several hormones affect bone health, including oestrogen, testosterone and parathyroid hormone, and so people with, or at risk of developing osteoporosis may see an endocrinologist.
• Gastroenterologists diagnose and treat conditions that affect the digestive system. This includes the oesophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. Gastrointestinal problems can occur in people living with conditions such as fibromyalgia, rheumatoid arthritis, lupus and scleroderma.
• Nephrologists diagnose and treat conditions that affect the kidneys. In some people with lupus and scleroderma, the kidneys are affected, and they may need to see a nephrologist.
• Neurologists diagnose and treat conditions of the brain, spine and nervous system. Some forms of musculoskeletal conditions can affect the nervous system and cause cognitive impairment (difficulties thinking or remembering), headaches, numbness or tingling sensations. Your doctor may refer you to a neurologist if you experience neurological problems.
• Ophthalmologists diagnose and treat eye diseases, perform eye surgery and prescribe and fit glasses and contact lenses to correct vision problems. Several conditions such as lupus, rheumatoid arthritis, juvenile arthritis, Sjogren’s syndrome and scleroderma can affect the eyes. Your GP or optometrist will refer you to an ophthalmologist if your eyes are affected by your condition.
• Orthopaedic surgeons specialise in the prevention, diagnosis, and treatment of disorders of the bones, joints, ligaments, tendons and muscles. They may do this using surgical and non-surgical treatments.
• Respiratory specialists diagnose, treat and prevent conditions that affect how we breathe (our respiratory system). This includes conditions that affect the nose, sinuses, throat, larynx, windpipe and lungs. People living with lupus or scleroderma may need to see a respiratory specialist if they experience issues with their respiratory system.

Whether you see any of these specialists will depend on your condition, symptoms, and their effect on your overall health and wellbeing.

Seeing a specialist

To see a specialist, you’ll need a referral letter from your GP or another specialist doctor. This will include information about your symptoms and test results.

You can visit a specialist in a clinic or a hospital. Depending on various factors such as where you live, the number of specialists available, the urgency of your situation, and if there’s a waiting list, you may see a specialist quickly, or you may have to wait.

Talk with your GP about the costs involved when discussing your referral. Medicare will cover part of the fee to see a specialist but not all of it. Specialist fees can be high, and depending on your circumstances and eligibility, this may influence whether you see a specialist at a bulk-billing hospital or in a private clinic. If you have private health insurance, this may also cover some of your costs. However, it’s essential to ask about fees and your choices before seeing a specialist.

The Better Health Channel suggests asking the following.

Does the specialist:

• work within the public or private health system?
• bulk-bill via the Medical Benefits Scheme (MBS)?
• require gap payments?
• have a payment plan?
• accept my private health cover?

Before your first appointment

When making your appointment, ask what information or test results you need to bring with you. The specialist may already have access to all or some of this information via your health records, but it’s a good idea to double-check.

You can also be proactive and create a file containing all of your results, records, medications and other treatments. Take it with you when you visit the specialist. That way there’ll be no potential delay in your assessment and treatment if your specialist can’t access some of your information. And make sure you include your referral letter.

Write down a list of questions about the things you want to know. This may be about diagnosis, treatment options, the benefits and risks of different treatments, costs, things you can do to manage better etc. Put them in order, with the most important questions at the top of the list. That way, if you run out of time, they’ll have been answered first.

Make sure you have an up-to-date list of your meds to take with you. This can be extremely helpful if your specialist hasn’t been able to access this information through online channels. You may want to use an app to keep track of your medicines so you always have this information with you. The MedicineWise app from the National Prescribing Service is free to download. You can create a list of your medicines by scanning their barcodes, set reminders for when to take medicines, store your test results and much more.

Consider taking a family member or friend with you. Healthcare appointments can be stressful, and having an extra set of eyes and ears can help you take it all in. They can also provide emotional support before, during and after your appointment.

During your appointment

The specialist will ask you about your symptoms and examine you.

Be open and honest when answering their questions. The specialist needs all the relevant information about you and your health to have an accurate idea of what’s happening and how best to treat you. They’ll need information about your medical history, other health conditions, treatments (both conventional and complementary) and lifestyle factors (e.g., how often you exercise, if you smoke, your diet etc.).

You may have one or more visits to your specialist before they have all the information they need. They may also send you for further tests. Once they have all the necessary information, they’ll explain your condition to you and what treatment they think you should have.

If you don’t understand what they’re suggesting, or you need more information, ask the specialist to explain further. Don’t be embarrassed to ask for this. Musculoskeletal conditions and treatments are complicated, so the more you understand, the better. And don’t be afraid to ask them to write things down for you.

After your appointment

Follow the treatment plan that you and your specialist have agreed upon. If they’ve requested you have further tests or book more appointments, make sure you do this as soon as possible.

If you’ve been prescribed medication, take it as instructed. If you can’t remember, or you’re not sure how to take it, talk with your pharmacist or call your specialist.

And for information and support between visits to your healthcare team, call our national Help Line on 1800 263 265 weekdays.

Contact our free national Help Line

If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

• How to navigate specialist fees in the private health system
  ABC Health & Wellbeing, 2019
• Informed financial consent – A collaboration between doctors and patients: Assisting patients to understand their health care and its costs (PDF)
  Australian Medical Association, 2019
• Paying for healthcare
  Better Health Channel, 2015
• Questions to ask your doctor
  healthdirect, 2020
• Seeing a specialist
  Better Health Channel, 2015
• What is a referral?
  healthdirect, 2021