2015
WORKING WITH YOUR DOCTOR
Presented by
Colby Evans, MD
Introduction
Colby Evans, MD
• Currently in private practice at Evans
Dermatology in Austin, TX
• Fellow, American Academy of Dermatology
• Chair, Board of Directors of the National Psoriasis
Foundation
Overview of today’s discussion
Today we’ll cover:
• How to locate a qualified health care provider for your psoriasis and/or
psoriatic arthritis
• How to prepare for your visits
• How to make the most of your time with your doctor
• Question and answer session
Connecting with the right specialist
• Typically, the type of doctor that can best treat psoriasis is a medical
dermatologist
• Rheumatologists develop long-term treatment plans for psoriatic
arthritis
• Look for doctors who are board-certified in these specialties
Dermatology
• Dermatologists emerge from their medical training with a broad
understanding of many different aspects of skin care
• Dermatologists may then choose to specialize further on topics like
specific skin diseases, skin cancer or cosmetic procedures
• The level of expertise and interest in treating psoriasis varies greatly
among dermatologists
Dermatology
• Certain doctors place a greater emphasis than others on treating psoriasis
patients and keeping up with the wide variety of medications
• Questions to ask:
• What array of treatments do you offer? Phototherapy?
• Do you have a nurse or medical assistant involved in obtaining approvals
for biologic medications?
• Are you involved in clinical trials?
• Will the dermatologist be able to see me fairly quickly if I experience a
flare?
Rheumatology
• A rheumatologist is a physician who has additional training and
experience in the diagnosis and treatment of arthritis and other diseases
of the joints, muscles and bones
• Treats more than 100 types of diseases, including arthritis, autoimmune
diseases, musculoskeletal pain disorders and osteoporosis
Rheumatologists
• Rheumatologists are specially trained to do the detective work necessary
to discover the cause of swelling and pain
• Four years in medical school, three years training in internal medicine, then two to
three years training in rheumatology
• It may be necessary to be seen by a rheumatologist multiple times to get
a correct diagnosis and an appropriate, individualized treatment plan
The doctor-patient relationship
• Remember, just because a physician is “good,” doesn’t mean that he or
she is the right fit for you
• There are many variables to consider:
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Focus on research
Size of practice
Teaching facility versus private practice
Personality fit
• Trust and comfort are two of the most important facets to the relationship
• Consider your priorities and expectations when setting out to find a new
health care provider
Resources for finding a doctor
• NPF Health Care Provider Directory
• www.psoriasis.org/find-a-dr
• Look for the President’s Council seal
• American Academy of Dermatology Directory
• www.aad.org
• Look for “psoriasis” or “medical dermatology” specialty
• American College of Rheumatology Directory
• www.rheumatology.org
Additional options
• Referral from your dermatologist for a rheumatologist or a friend
• Check the online database provided by your insurance company, or
call your insurance company directly for options
• Be wary of trusting all online doctor reviews
• Remember the possibility of selection bias!
Before the visit
• Spend time considering:
• What do you want to get out of this visit?
• New treatment plan
• Questions about existing prescription
• Keep (and maintain) an inventory of your medications:
• Names and dosages (how much and how often you take it)
• Prescription drugs, over-the-counter medications or supplements
• Consider bringing a close friend or relative to the appointment with you
• Someone that knows you and your condition well, can help with taking notes, asking
questions, etc.
Other materials to prepare
• Bring a list of the past treatments you’ve used for psoriasis or psoriatic
arthritis
• And the reason for discontinuing each of them
• Recent medical records (approximately 5 years) can also be helpful if
you’re seeing a new doctor
• Names and contact information for other health care providers that you
see
Preparing a list of questions
• It’s a great idea to put together a list of questions before your visit, but
rank them by priority
• Remember there may not be time to get to all of the questions within
the visit
• Be prepared to think and ask questions on the fly, too
Gathering your thoughts
• Be ready to briefly answer the following questions when you get to your
appointment:
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What symptoms am I experiencing?
When did they begin?
What makes the condition better or worse?
What are my questions or concerns?
• Communicate clearly
•
Be ready to describe symptoms as precisely as possible
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For example, instead of saying, "My knee hurts," say "There is a sharp, piercing pain on the outside of
my left knee, under the knee cap"
This can help your doctor narrow the list of possible diagnoses, prevent extra tests
Do your research
• Learn about the treatment options available to you so you can ask
questions and be knowledgeable
• But be open to the expertise of your doctor
• Remember to be a skeptical consumer and learn from reputable websites
and resources
What to expect
• The mean visit time with a dermatologist is 9-12 minutes
• Average time with a primary care doctor is 18 minutes
• Arrive about 15 minutes early to complete paperwork and ensure that
you’re able to be seen for your complete appointment window
The waiting game
• Try to get an appointment in the early morning or after lunch for shorter waiting
times
• Patience pays!
•
The average patient waits 19 minutes for a scheduled appointment
• When you check in with the receptionist, ask the approximate time you should
expect to wait
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If you have been waiting longer than 20 minutes, ask nicely how much longer you should
expect to wait
Try your best to stay occupied and positive
• How comfortable and relaxed you are in the waiting room will influence your
experience in the exam room
Honesty
• Being honest and open is critically important to getting the best care
possible from your health care provider
• Remember your doctor can only treat you based off the information you provide
• Are you concerned about potential side effects from one of the prescribed
medications?
• Are you uncomfortable with the treatment plan your doctor has prescribed?
• Speak up!
Remember…
• Your doc has heard it all!
• Your concerns, fears and questions about treatment are valid and are
nothing to be embarrassed about
• If your doctor is recommending a treatment that you don't think is right for
your lifestyle, let him or her know
• It's okay to ask about other treatment options
Communication is key
• And the stakes are high!
• Several studies have indicated that good doctor-patient communication
resulted in:
• Lower blood sugar levels in diabetic patients
• Lower blood pressure for patients with hypertension
• Reduced pain for patients with cancer and other illnesses
• But the converse is also true: miscommunication with your doctor can put
your health at risk
Making sure you’ve got it right
• Don't hesitate to use the words "I don't understand"
• Never feel embarrassed or shy about asking for clarification about
something the doctor says
• When in doubt, repeat back what she has told you and ask if you
understood correctly
Talking about PsO / PsA
• Psoriatic disease is more than skin deep
• Speak up about any emotional impacts you face – it could make a large
difference in the treatment plan that your doctor prescribes
• Do you have psoriasis symptoms in an intimate area or area that is
covered by your clothes? Speak up!
Expectations for treatment
• Talk with your doctor about your treatment expectations and make sure
you’re on the same page
• What level of clearance would you be happy with?
• What type of treatment schedule would work with your lifestyle?
• What area in particular do you want to target through treatment?
• Example: skin site, like scalp or hands and feet; dating/sex life
Before you leave the appointment
• New prescription?
• Ask for a printed copy of all instructions for use and any educational materials
available
• Materials are created by the National Psoriasis Foundation, the pharmaceutical company,
or your doctor’s office
Talking about side effects, risk,
benefits
You’ll want to have a conversation with your doctor about both the most
common side effects and most serious risks of your treatment
Possible conversation starters:
• Will I be tested regularly for unwanted side effects?
• Can this treatment be stopped suddenly, or do I need to stop it gradually?
• If I decide against this treatment, what are my other options?
After the appointment
• Have questions? Is the prescription at the pharmacy more than you thought it
would be? Are you waiting to hear about approval status from a specialty
pharmacy?
• Contact your doctor’s office for updates and advice
• A follow-up appointment may be necessary
Sticking with the treatment
• It’s generally recommended to give a new treatment 8-12 weeks to see if it
will work
• 50% of all treatment plans are not taken as prescribed by doctors
• In many cases, using treatments properly can make a significant difference
in results
• If your symptoms are worsening while taking your new treatment, or if you
are experiencing severe/unexpected side effects, call your doctor
Barriers to proper care
• It’s important to talk with your doctor about any roadblocks you can foresee
that would prevent you from taking your treatment as directed:
• Cost
• Insurance changes ahead
• Confusion about the treatment protocol
• Fear of side effects or long-term risks
Question & answer session