How to Get the Most from Your Dermatologist

I have never had a good dermatologist, but I know they are out there...

I think as someone who has grown up with psoriasis, I developed some lousy dermatology habits. These habits include expecting too much from an appointment and not demanding higher standards. Having poor quality consultations from the age of 5 meant that I had low expectations and it is only now I understand what we need to do to get the most from our dermatology appointments.

Get prepared

Dermatology appointments are very short. Your dermatologist has a lot of paperwork to do before you enter the room and once you have left. In the UK the typical appointment time is around 10 minutes for an NHS consultation.¹ In this time your dermatologist has to assess how you have progressed since the last appointment, record any changes, review your medication and check your mental health. It does not leave much time for discussion.

If you enter your appointment prepared, then you can save time to focus on what you want to talk about. You can journal your physical symptoms and how they affect you emotionally. This means that your doctor can see clearly from the start how effective the treatment is both in the management of symptoms, but also in the context of your life, and they can quickly assess how well you are coping mentally with the challenges of living with psoriasis. If this saves two minutes, you have gained an extra 20% of the appointment to talk about what you want and need.

Recording your emotional state also opens up a dialogue about any mental health challenges you have been facing and can open up options for you to be referred for additional support that may have been missed if you had waited for your dermatologist to ask the right questions.

Know what you want

It is so easy to turn up to an appointment with your doctor and just expect a cure/treatment/resolution protocol. Just like we do when we have a cold, and we get a prescription for antibiotics we hope for a prescription to clear our skin (at least I did). Unfortunately, psoriasis is so much more complicated than terminating a microbe. So have clear expectations, this will give your short consultation a clear focus towards your needs and not your dermatologists typical to do list.

• When we turn up to an appointment without clear expectations, we can very easily leave feeling dissatisfied. So we need to start off knowing what we want to achieve. Here are some examples to get you thinking:
• Are you applying your topical like a moisturizer? If so it is important you tell your doctor that this treatment is not working. Spending 45 minutes twice a day applying cream affects your quality of life, and that is a justified reason for demanding a change in treatment.
• Is the systemic you are taking ruining your sex drive? This is a great reason to ask for a review. Focus this appointment on reviewing alternative systemic treatments, or other solutions to mitigate the side-effects if you decide to stay on the drug you are on.
• Do you feel frustrated with your condition? Having a clear and honest conversation with your dermatologist can allow you both to spend the time needed to develop an action plan to move forwards- whether that is an approach for your skin, mental health support or both.
• What do you want from your next appointment? What would happen to help you leave feeling satisfied?

Know your options

I was offered methotrexate in my early twenties and took it readily. I did almost no research. I had some side effects, I developed IBS symptoms which required additional pharmaceutical intervention, and I bled randomly during sex. A lot. I do not think I even read the patient information sheet inside.

Now I am older and wiser I always read the patient information leaflet and try to plan ahead. In most cases the escalation of treatments for psoriasis follow a relatively predictable path (unless you have psoriatic arthritis in which can you often get to skip to the biologics quicker). The path is topicals --> light therapy (pUVA/nbUVB) --> Systemics (commonly Methotrexate and Cyclosporine) --> Biologics. Therefore if you are failing on light therapy, then there is a good chance that you are going to move onto a systemic. It is worth researching both cyclosporine and methotrexate before your next appointment so you can have an open, informed and frank conversation about what life will be like if you take these medications and you can ask the questions that have arisen from your research, so you can make the most informed decision.

If you don't like your dermatologist, do something about it

If you do not like your dermatologist, then get another one. It sounds too easy in our convoluted health care systems, but it is actually rather simple. You start by asking the admin people at your dermatology surgery. Swapping to another doctor in the same office is easy and relatively common so don't feel embarrassed (plus you can ask them by phone if you prefer). You may worry about bumping into your rejected dermatologist in the waiting room but don’t, if you didn't like them, there is a chance they didn't like you either, so this move is probably best for both of you, just smile and say hello (or hide in your magazine).

Swapping to a different surgery depends on your healthcare system. In the U.K you can swap to any NHS hospital. Moving outside of your Primary Care Trust requires a reasonable amount of paperwork, so you are going to need to sweet talk your General Practitioner or G.P. In the U.S this may depend on availability in your area, and your insurance so make sure you ask your dermatology office for the best place to start the process. The National Psoriasis Foundation has Patient Navigators who are trained in this area so you can call for advice, so this is also an excellent option for more support.