2015

WORKING WITH YOUR DOCTOR

Presented by Colby Evans, MD

IntroductionColby 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:• 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:• 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

• 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• 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, benefitsYou’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