Dermatologists

[Forest Walker]

I saw a dermatologist in April 2021 who took two punch biopsies and prescribed the betamethasone and desonide ointments.   The only caution he gave was that they could thin the skin.  

And he provided a 12-month refill supply for the ointments.  His manner was terse, quick, reluctant.  He came across as arrogant, conceited, not very into dermatology but more into power within his practice.  All the staff in the office were young, attractive women, too.

I will be seeing a new dermatologist next week.   This doctor is new to the area (as I am, too, having moved here a year ago).  Part of her training was at Oregon Health Sciences University where I had gone for consultations relating to Crohn's Disease before starting Humira in 2007.  At least, I feel confident in OHSU as the best Oregon offered for medical care.  And it gives me hope that this doctor will be more approachable and may take the time to explain options and help me understand.  

Psoriasis Club has helped me more than the dermatologist I saw in April.  It has given me hope that these daily miseries of the skin will ease.

Do you have advice for this upcoming visit?

Have you ever encountered a doctor who really should never have become a doctor?

Have you had exceptional care from your dermatologist?  What does exceptional care look like?

What is the best of the best or the worst of the worst?

Thank you.
FW

[Fred]

Do you have advice for this upcoming visit?

You may not be allowed do to covid, but if it is possible take someone you live with to your apointment. It helps to have someone beside you who knows how it is effecting your life, and it also helps them.

Do both of these in advance and take them with you.

What is the PASI score my dermatologist uses ?

Dermatology Life Quality Index (DLQI)

Have you ever encountered a doctor who really should never have become a doctor?

Yes most of the ones I used to deal with in the UK especially dermatology, but that was a long time ago.

Have you had exceptional care from your dermatologist?  What does exceptional care look like?

Yes I have a great relationship with my dermatologist, she listens to what I have to say, I can phone her if needed and my last visit was just over 1 hour.

What is the best of the best or the worst of the worst?

Not sure what you are asking there 

[Turnedlight]

The care varies from great to awful, all within the same department at the hospital.

When psoriasis is really bad, it really is a crisis for the sufferer and it can be hard to take when no one seems to realise just how bad it is and how you’ve had no sleep, you are not just itching but in pain, you feel dreadful etc.


I think a punch biopsy sounds a bit of overkill, I know they do it if checking for cancer but I though psoriasis was diagnosable by looking and asking questions. Though perhaps they weren’t sure with your symptoms?


I often try to go to the derm knowing what I want, ie to stay on treatment, or to change it to something similar, or try and ask for something new like maybe a treatment I heard about on here.
Of course it’s then dependant on whether they agree or can even prescribe it, but I think it’s good to have some thoughts to give them.


So asking for something that might help both the crohns and the skin might be a good place to start?


Yes I have met terrible doctors who are quite happy for patients to languish and suffer on many different drugs with many different side effects, and get all huffy if you don’t get on with them like it’s you being the nuisance and not the drug.

I once read that if you say a drug isn’t working, they are taught that the most likely reason is you haven’t been taking it.
So we start off on the footing that doctors are told to assume most of us are liars.
That’s fab isn’t it?
I hope it’s not true..

[Kat]

Lots of good questions!

I remember having a doctor who was well liked by many and well respected in the medical community but for whatever reason... I didn't click with him. So sometimes I think it's a matter of finding that person that you connect with and also since the majority of doctors are in groups now as opposed to the old solo practice of the past, finding a doctor that isn't trying to see 100 patients a day is a priority for me! I had a doctor I loved who always spent time talking to me and he built that doctor / patient relationship. He then moved into a LARGE practice and now he comes in and spends about 5 - 10 minutes with me because he's already behind schedule. I think they schedule appointments every 10 minutes there! But... he's such an excellent doctor I do still see him on occasion. Thankfully I haven't needed him in a long time now.

Just find the doctor YOU are comfortable with and you feel has your best interest as a priority.

I've always been with the same group of dermatologist. It's a large group but they do well at spending time with you. The dermatologist I see has moved so I will be seeing one of the other ones next time.

Good luck!

[Forest Walker]

Just as sharing about your psoriasis and psoriatic arthritis helps others, reading about your experiences in the medical system, your experiences with doctors, lightens that feeling that you are all alone with this and increases the understanding of how different practices operate, how to be prepared for appointments.  

It's fun to join in the "Off Topic" areas and get to know members here, but the help for living with Psoriasis and making the best decisions is so very valuable in this club.  Fred, this forum has already helped me and is continuing to help.  I'm really glad I found Psoriasis Club.  (I know it sounds like I'm too much on gratitude, but it is really sincere gratitude, and I can't help feeling it.)

Thanks, Fred, TL, and Kat for your replies.  

Fred, the PASI and Quality of Life Index and links--so helpful!   

TL, the punch biopsies were also really expensive.  Not only the dermatologist fee for taking them in addition to the exam fee, but also then paying the pathologist.  And he started out by saying it looks like psoriasis but we need to take samples to be sure or in case it's something else.  I will be asking about treatments I've read about here.  

Kat, your doctor who was able to spend time building relationships with his patients when he was in a smaller practice and then was forced to rush through so many . . . that must have also been stressful for him.  I wonder if it made his enjoyment of medicine lessen or if the extra money he may have earned made up for that.

[Fred]

Fred, this forum has already helped me and is continuing to help.  I'm really glad I found Psoriasis Club.  (I know it sounds like I'm too much on gratitude, but it is really sincere gratitude, and I can't help feeling it.)

You are welcome, just leave me a bucket of Merlot in the bar.

[Caroline]

Always take the three questions with you :

1. What are my possibilities?
   
2. What are the advantages and disadvantages of that possibilities? 
   
3. What does that mean in my situation? 
   

[Kat]

I agree with Caroline that it's good to go in and ask questions!

As for my doctor that entered the large practice, according to his nurse he wasn't making much money after paying for his office, staff, insurance, etc. And he had about 6 kids I think it was (ALL boys!) ranging from baby only up to about 10 years old if that. So his decision was motivated by money. I'm sure he makes a lot more now, but he doesn't smile as much as he used to and I would guess it is much more stressful where he is now.

Just make sure you find the one that's right for you! And being here opens up lots of treatment information that you can take with you when discussing things with your dermatologist. I have found that to be very valuable!! Instead of just going with what the doctor tells me, I have questions and suggestions based on information I've learned here so I feel I'm more of a participant in my treatment.