10 Clues That It’s Time to Switch Dermatologistsby Tracy Davenport, Ph.D. Health Writer
The dermatologist who treats my psoriasis is funny, smart, and the kind of person I want to hang out with after work. But I know that not everyone is so lucky. In fact, fewer than 35% of Americans say they feel confident in medical leaders, according to 2014 research published in The New England Journal of Medicine. While that's pretty discouraging, the good news is that you don't have to settle for less-than-stellar care. Here are 10 clues that it's time to find a new Dr. Right.
Dinosaur doctors are not extinct. Once in a while you may run into a physician who is practicing medical paternalism, which means what she says is what goes, and your wishes and priorities are left in the dust.
But today’s standards are different. As a patient, you’re the expert on your body, and decisions about how to treat it are made together; you and your doctor are a team. If you feel your dermatologist is giving you advice without taking what you want into account, it’s probably time to move on.
You Don’t Trust Him
It can be hard to get a good handle on your dermatologist’s level of knowledge. But there are ways to figure this out. One of the easiest is to confirm that your derm is board-certified. Log on to the American Academy of Dermatology Association and look your doc up using the Find a Dermatologist tool.
“Trusting the care you are receiving from your physician is crucial,” says Rick Wirtz, Psy.D., a behavioral psychologist in Chestertown, MD. “If that trust has been broken by a lack of responsiveness to issues of concern, or lack of positive results, then, at the very least, a second opinion is warranted. Remember, the medical provider works for the patient!”
You Feel Frustrated and Down After Appointments
There’s a mental as well as a physical component to psoriasis; when we don’t look good, we don’t feel good. And vice versa. Ideally, the dermatologist is part doctor and part cheerleader. When you leave your appointments, you want to feel encouraged and hopeful about marching out into the world again.
If instead you dread the visits, or have to pick yourself up emotionally after walking out the door, it might be time for a switch. As with any relationship, you can also just try telling them you need more encouragement--and that your psoriasis will improve. This may work!
It’s Nearly Impossible to Get Appointments...
Especially when you’re having a psoriasis flare-up, it’s important to see your dermatologist sooner rather than later. But a study in JAMA Dermatology reported that, on average, people wait 56 days (and a median of 41 days) to see their derm. That said, doctors do vary in how they handle between-appointment issues. Mine asks that I call if I notice signs of a flare, then they decide how to respond based on what’s going on. So while you might not get in to see the doctor right away, you should at least know that help is there, even if it’s just for a medication update that’s ordered over the phone.
... And He Often Breaks the Ones You Do Have
There’s a good chance that if you have psoriasis, you’re already managing primary-care appointments, eye appointments, and more. Too many unexpected changes to the calendar can make an already-tough job feel impossible. Not to mention that waiting for a later appointment can give your condition a chance to worsen.
If you live in a more rural area like I do, you've probably had specialists cancel on you. Time demands on these overscheduled physicians are intense, with a single emergency forcing them to overhaul days of appointments. Obviously, things come up. That’s life. However, if it seems like rescheduling is the new norm, it may be time to find another practice.
She’s Really Quick to Write Another Prescription
Psoriasis should always be treated not only to manage current symptoms but also to help prevent complications (including psoriatic arthritis) later. But if you feel like your dermatologist is prescribing too many treatments at once, without carefully tracking the results or taking other health conditions into account, it may be time to move on.
Almost all medications, even the best ones for psoriasis, can cause side effects. And some react with other medicines. You can always ask, “Why this medicine?” and “Why now?” and “For how long?” and expect a clear and thoughtful response. Just throwing another prescription at the problem, without careful reasoning and justification, isn’t a solution.
Your Psoriasis Isn’t Getting Better
There’s no cure for psoriasis. But there are expert-approved guidelines that can help move things in the right direction. The goal: to help them achieve clear or almost clear skin.
Published in the Journal of the American Academy of Dermatology in February 2017 are expected treatment goals for the treatment of psoriasis. Ideally, the condition should cover 1 percent or less of your body within three months of starting treatment. If you’re not seeing improvements in this amount of time, and your dermatologist isn’t willing to help you change your treatment course or strategize for another approach, you know what to do.
He Doesn’t Play Well with Your Care Team
Psoriasis is complex, and it may take help from a variety of different medical professionals to help you do well. You need a dermatologist as well as a primary-care physician and possibly a rheumatologist. As with any team, it’s important that the doctors work well together, making sure that your health is their number one priority.
For example: The medicine I take for my psoriatic arthritis works well for my joints but not my skin. My rheumatologist and I agree that getting my joint issues stabilized is the most important goal right now, and his office communicated this to my dermatologist—which is a good thing.
Once You’ve Decided: No-Sweat Strategies for Making the Switch
If you're ready to find a new dermatologist, start by calling your favorite healthcare provider for a list of recommendations. You can also ask your employer or insurance company for patient-advocate services for help. If you’re in a rural area with few choices of specialists like dermatologists, consider trying telemedicine, which allows you to visit a board-certified dermatologist quickly via your phone or computer. Currently 35 states and DC require private insurers to reimburse healthcare providers for services delivered through telemedicine.
How It All May Feel
Switching dermatologists may feel like a breakup, and breakups generally don't feel the greatest. When it comes to weighing the pros and cons of a derm switch, keep in mind that if you and your doc just aren't a good match, it's not necessarily anyone’s fault. No need for bad feelings.
And: If your doctor isn’t the right match for you, it is very possible that you’re not the ideal patient for him either--and finding a new doctor may be a positive move for everyone.