• referral to rheumatology

People with severe IA and/or show positive markers for RA in their blood tests may be referred to a Rheumatologist. If you have medical insurance, or can afford to pay yourself, you can request that your GP refers you to a private Rheumatologist. Otherwise if the GP determines it is appropriate, you may have a referral to the Rheumatology Clinic at Taranaki Base Hospital, or the outreach clinic in Hawera.
A referral to an outpatients department can be daunting at any time. Even more so if you have no previous experience of how the health system referrals process works. There is lots of advice about what to do to prepare for your FSA, but no formal advice.

Referral FAQs

Your GP or other medical specialist has referred you to a Rheumatologist to investigate symptoms that suggest you have an Inflammatory Arthritis. There are several types of Inflammatory Arthritis and the GP will ask questions, examines joints and skin, as well as asking you to have a diagnostic blood tests to try and determine which IA you have, if any. Sometimes it’s very clear that you have an Inflammatory Arthritis, and which type it is. At other times it is not clear but the combination of questions, physical symptoms and blood test results have suggested further specialist investigation is required.
Who can refer me to a Rheumatology Clinic?
Referrals can be made by medical practitioners like your GP, or another sedical pecialist. Allied health practitioners (e.g. physiotherapists, osteopaths) should recommend you see your GP if you have symptoms of an IA.
How does referral work?
An electronic referral letter is sent to the public rheumatology clinic or, if you have chosen, a private rheumatologist. The letter will contain a description of your symptoms and the tests the GP has performed to determine the reason for referral, the information in this letter is basis for scheduling your appointment.
After the referral is processed by the clinic, you and your GP should receive an acknowledgement of the referral from the DHB in 15 days or less. The response will:
  • Accept the referral for a First Specialist Assessment
  • Ask the GP for more information
  • Reject the referral
The referral is triaged and prioritised. If your referral has been accepted an appointment date will be sent to you at the address listed on the referral letter. If you have been referred to the DHB rheumatology service in Taranaki you should expect your appointment to be within four months of the clinic receiving the referral letter.
The clinic will send (mail or text) a reminder within the week of your appointment. If you cannot make your appointment, or feel you no longer need it (note that your referral was indicated on a number of clinical factors as well as your symptoms so be cautious in declining a referral), please advise the clinic as soon as you can. Your appointment space can then be used by someone else on the waiting list.
If you cannot make the appointment more than once and do not advise the clinic there is a risk that you may have to begin the referral process all over again.
Please make sure your GP and the Rheumatology Clinic have your correct home address and phone numbers, especially if you move home or change numbers between referral and your appointment date.
What are my referral options?
In Taranaki, the public health system has a Rheumatology Service at Taranaki Base Hospital and an outreach clinic in Hawera. These clinics are run by Dr Raj Kumar. Dr Alan Doube, a Rheumatologist from Hamilton sees public health patients at Taranaki Base Hospital one day per month.
Private Rheumatology care in Taranaki is also provided by Dr Kumar and Dr Doube. Referrals to these private clinics must also come from your GP or other specialist consultant.
Why is your notification delayed?
  • The referral was not completed or not does not have enough information
  • Waiting lists are long and the referral cannot be completed within the expected timeframe.
  • Your appointment notification may have been misplaced (have you recently changed address?)
Waiting times
  • Your waiting time for your first specialist appointment at Taranaki base hospital or Hawera may be longer than four months.
  • The two rheumatologists consulting at the Taranaki Base Hospital also run private clinics so you can choose to see them as a private sector patient. If you have private health insurance, your insurer may have a preference about who you see. If you are paying yourself, the costs are significant.
  • You can consider seeing a rheumatologist outside of the Taranaki region. Hamilton, Auckland, Wellington and Rotorua have private Rheumatology Consultants who may be willing to see you as a new patient. The costs of seeing a consultant out of area will need to be covered by you or your health insurer.
  • In the public health system you are assigned a rheumatologist for your FSA. If you have problems with a rheumatologist, you can request a change. Your options are limited and the problem you have with the rheumatologist you have been assigned to must be significant.

Waiting for your First Specialist Assessment (FSA)
Often inflammatory arthritis sympoms are not stable. Pain and swelling can move around the joints - sometimes it is visible, showing redness and swelling and sometimes not. It helps if you can keep track of the pain and inflammation over time. Please see your GP if you are struggling to manage pain, daily tasks or your mental health is suffering.
Patient Tips:
  • Take photos of red, swollen joints
  • Keep a diary of pain and swelling
  • Write down which joints hurt and when they are sore
  • Record the medications you have taken. Your GP may have prescribed you medications that can temporarily reduce the signs of an IA and it would be helpful for the Rheumatologist to know what changes you have noticed.
  • Record any vitamins and health remedies like fish oil, turmeric etc.
  • Note activities if they seem to be related to new inflammation
  • If your pain and inflammation continues to significantly affecting your daily life, or any other health concerns occur, contact your GP. They may be able to prescribe/adjust medications to ease the symptoms.
  • If there is a change in your condition, e.g. if it worsens suddenly, see your GP urgently
  • If you are unable to care for yourself or other family members and cannot rely on family or other members of your social network to keep you safe, discuss this with GP. You may be eligible for Home Help, or they may point you to people who can assist.
Your First Specialist Assessment
Usually you are referred to confirm a suspicion of IA, not to rule it in or out. Blood tests for markers of disease and inflammation are essential in this process, If they have not been done, or are inconclusive the Rheumatologist will most likely request these before treatment decisions are made. X-rays and MRIs are not usually required for a first FSA and depending on the Rheumatologists assessment, they might not be requested after the FSA. Rather than helping with diagnosis (although in some cases they may be needed for confirmation) an x-ray can provide a baseline for disease progression. After diagnosis they may be requested for this purpose. The examination process is likely similar to what you experienced during the referral appointment with your GP, but with a more intense or extensive physical examination. If the Rheumatologist diagnoses and inflammatory Arthritis a treatment plan will be suggested. Recommended medications will depend on your personal circumstances, the RH assessment of pain, inflammation and the impact of the disease on your quality of life and the rh assessment of the likelihood of joint damage. Patient Tips
  • Have a support person with you if possible. There is a lot of information to take in and you may also need that person to fill in the gaps if you forget to mention important symptoms and events related to your symptoms.
  • Arrive early – there is likely to be paperwork to do before your appointment
  • Wear comfortable clothing. Your specialist will need to examine and manipulate the joints that are causing you problems
  • Have your diary/photos handy. Explain your symptoms as the Rheumatologist asks, but don’t try to explain them unless you need to, give the Rheumatologist space to consider your symptoms and blood tests first.
  • Don’t forget to mention daily activities you are finding difficult to do. Including employment, personal care (washing, dressing etc.), childcare, driving and activities such as housework, walking, using stairs, opening doors, sport and leisure activities.
  • Ask questions about anything you do not understand, or have your support person ask them for you.
  • Take notes, especially concerning the medications that you have been prescribed - their purpose, dosage, monitoring and what side effects to look out for.
  • Make sure you know how to contact the rheumatologist, the nurses clinic or office before you leave your FSA.
Cautions apply with this information: Despite commonalities in IA processes and treatment, we're all individuals. Your unique circumstances may affect processes and appearance of your IA. Referral processes and resources available to you can also vary by area.

ALWAYS seek clarification from your medical team.
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