Following a diagnosis of psoriasis—a chronic autoimmune disease marked by red, itchy, scaly patches—a patient’s next step is to find the best doctor for long-term treatment. There are many factors that may influence this decision, including doctor location, cost and credentials. Asking the right questions—from where to look for a dermatologist to how to develop a successful long-term patient-doctor relationship—is a crucial to ensuring that patients make the best choice for their specific needs.
Where to look for a doctor
Patients with psoriasis may be treated by a primary provider; however, in order to have the best possible care and the most treatment options available, they should seek the care of a specialist, such as a dermatologist. Dermatologists are particularly helpful for patients with moderate-to-severe cases of psoriasis because they typically have more familiarity with prescribing psoriasis treatments than do primary providers.
There are many resources to help people diagnosed with psoriasis locate a doctor with whom they feel comfortable. If a patient has a general practitioner who they see regularly, asking him or her for recommendations or referrals is a good place to start.
Aside from asking their primary care physicians for recommendations, patients with psoriasis can also refer to certain organizations, such as the National Psoriasis Foundation and the American Academy of Dermatology, whose websites allow patients to do a specialty search by type of therapy and location, and to look specifically for board-certified psoriasis specialists. Patients can also check their insurance company’s database of preferred providers.
Another place to look for psoriasis specialists is at medical schools, since many dermatologists work at a university hospital alongside resident physicians who are in training to be dermatologists. However, if someone prefers a one-on-one, more private doctor-patient relationship, a dermatologist at a university hospital may not be the best fit. That said, hospital and university systems usually offer a lot of treatment resources; for example, patients are more likely to have a phototherapy center there, or an infusion center, and they are more likely to have more opportunities to participate in clinical trials.
After a patient with psoriasis identifies potential doctors, the next step should be to set up a consult, or an initial appointment, in which he or she can find out more information about the doctor and the practice. Setting up a consult is an important step for patients to feel empowered about having a choice and not having to commit to a doctor with whom they don’t feel completely comfortable.
Consults are very short—oftentimes limited to no more than 15 minutes—thereby making it critical for patients to do research and prep work beforehand so they can get the most out of the appointment. If the doctors’ offices have information on their website about what services they offer for psoriasis, patients should seek that information first. Prep work may include writing down symptoms, patterns of flare-ups and observations about triggers.
Patients should also write down a list of questions and have them answered during the consult. Kathleen Carter, Outreach Manager for the National Psoriasis Foundation (NPF), suggests the following questions for psoriasis patients to ask a doctor:
“How many patients with my type of psoriasis do you see in a given month?” The doctor’s answer will give you a barometer of his or her level of familiarity with treating other people with psoriasis.
“Are you primarily a medical or cosmetic dermatologist?” Many dermatology clinics have some cosmetic component to their practice, but patients with psoriasis will usually be better off being treated by a dermatologist whose experience is mostly in medical dermatology and psoriatic disease management.
“Do you believe that my symptoms can be managed, and to what degree?” Patients should seek a specialist who can clearly communicate how he/she plans to deliver the most effective treatment for their psoriasis.
If a patient has multiple medical conditions, he or she should ask, “How can I manage my other medical condition(s) and psoriasis together?” The doctor should help patients make sure they don’t do anything to negatively impact other conditions they may have.
Asking these questions will help patients gain a better understanding of the doctor’s level of expertise. Patients should also look for a doctor who asks them a lot of questions; gathering information about symptoms and previously-tried treatments and results will help inform what treatments the doctor will prescribe next.
Talking about treatments
Patients should ask questions specifically about psoriasis treatments both during the initial consult and in any subsequent visits. Carter suggested the following questions:
- “What type of treatment options do you make available to your patients?”’
For example, patients may want to know whether the doctor has a phototherapy unit on site, or if he/she primarily prescribes biologics. Generally speaking, it is better to have many options available.
- “How will you determine whether I am a good candidate for different treatments? What factors play into deciding which treatments are best for me?”
The doctor should be able to explain what treatments should be prescribed for the patient and why.
- “What are the possible side effects of some common types of treatments?”
The doctor should explain any possible side effects and how the patient can manage them.
- “How effective do you think (specific types of) treatments are going to be for me?”
While doctors cannot predict with complete accuracy how successful a specific treatment will be for a psoriasis patient, they can refer to fact sheets that medications list on their sites. The National Psoriasis Foundation also has condensed versions that list the effectiveness of different psoriasis treatments.
Following a doctor’s prescription for psoriasis, the questions that patients ask may help dictate the level of success regarding treatment. Below are questions for which patients should be sure to have answered before they leave the physician’s office:
“How effective do you think (specific types of) treatments are going to be for me?”
“What type of drug are you prescribing for me, and how does it work?”
“How often, and for [n1] how long, will I need to take this medication?”
“When should I expect to notice improvements in my skin?”
“Is it safe for me to use this medication if I’m pregnant or breastfeeding?” (if applicable)
“What course of action should I take if I experience any side effects?”
“What are the risks if I don’t take my medication as directed, or if I forget to take it?”
“Has this medication been tested in people with my type of psoriasis? Are there any recent research studies on it?”
“Will I need to have blood tests or other monitoring while I’m taking the medication?”
“Is this drug habit-forming?”
Detailed specifications about taking a prescription drug are important for a patient’s psychological health, as understanding the exact process of taking medications will help put a patient’s mind at ease. Failing to follow exact instructions can also have serious health consequences; for example, if a patient is prescribed a topical treatment for psoriasis on the elbow, then uses it for psoriasis that develops under the breast, side effects could occur. So it is a good idea for patients to ask the questions above in addition to getting the doctor’s specific instructions in writing.
Long-term patient-doctor relationship
The doctor-patient relationship should resemble a partnership, and being able to trust and communicate honestly with your provider will make a difference in your health. According to the National Psoriasis Foundation, studies have shown that patients who are well-educated and receive helpful resources from their healthcare provider have better odds of treatment success, compared to patients who doesn’t feel comfortable or informed at their doctor’s office.
One big reason why building a good relationship with a doctor is so important is that it will help him or her know when a patient should switch medications. In-depth conversations over time—about what the patient has tried, how long it was used and what other options are available to explore—are necessary in order for the doctor to better understand the patient’s levels of clearance and his or her history and personal feelings about certain treatments. Building a good long-term patient-doctor relationship may also be beneficial for psoriasis patients because doctors can make and adjust recommendations for a psoriasis patient’s lifestyle, including diet, exercise and skin care routine.
Good long-term patient-doctor relationships are especially important if a patient with psoriasis has multiple doctors for multiple conditions. Psoriasis patients often have health conditions associated with psoriasis, such as psoriatic arthritis, in which case they may have a primary care physician, a dermatologist for skin symptoms and a rheumatologist for joint issues. In such cases, it is helpful for patients to work with providers who are willing to be team players and who are willing to communicate regularly and often with the patients’ other specialists.
“Psoriasis is a disease that’s more than skin deep,” Carter said. “Psoriasis has far-reaching effects on your overall quality of life, and it makes all the difference for your treatment plans and peace of mind to be working with doctors who you know you can call on when you need them.”
Carter, Kathleen. Telephone interview. 6 Dec. 2013.