Table 4 Barriers that need to be addressed to implement improved screening and early detection

Additional education for primary care doctors

“The education of the physicians. The ankylosing spondylitis is one of the most common forms of arthritis but yet they don’t look at it as -- and that is something that they need to be educated on.” (65 year old female)

Improve physician empathy, persistence, relationship with patient

“The doctor/patient relationship is huge.” (54 year old male)

“if you have a good relationship with the doctor and you’ve done your homework It should be a partnership, and that’s what I would recommend” (66 year old male)

Physician assumptions: drug seeking, hypochondriasis

“Yeah, the pain, and they look at you… what do you mean pain, they just look like they have no idea that you’re in pain… And they look at you like well, nowadays, it’s even worse with the opioid crisis…” (65 year old female)

Improve access to specialists and care coordination

“I tried to make a point to emphasize the care coordination call because that, when all these doctors talked to each other, that’s when like everything kind of clicked… I think more care coordination or just -- or just maybe something where doctors talk to people who are not in their field, you know?” (34 year old male)

Not enough rheumatologists

“There’s limited rheumatologists and it’s hard to get in with them unless they know something’s wrong with you” (28 year old female)

Make time and information available

“When I go to a doctor if I’ve got questions I write them down so I don’t forget, okay? And I had a doctor ready to leave the room after an exam and I said wait a minute, I’ve got more questions. And he said I’ve got more patients…” (73 year old male)