Doctors Need to Live in the Real World

Have you ever asked your dermatologist a question and they didn't really answer it? Their answer sounded rehearsed, like a live reading of a medical textbook.

This word for word answer leaves you feeling a little unsatisfied. A bit like when you order a chocolate milkshake, and you get skim milk and low-fat cocoa.

Frustrated with psoriasis

Some problems are well known among doctors. Drug compliance is a great example. Typical drug adherence rates are around 50% and the number of us taking the correct dose, at the correct time drops dramatically after 6 months of treatment.

Chronic conditions like psoriasis are particularly vulnerable to sub-optimal results as a result of not taking as our medications as prescribed.

Doctor patient frustration

So is it my fault? Absolutely not. Research shows that people who require long-term pharmaceutical support may need counseling and to enlist the support of friends and family to help them maintain their drug-taking schedules.

Will you please just answer my question? I often know as the doctor is writing my prescription that my compliance is going to be poor. I highlight this every time. Almost every time, the doctor recites merely the official guidelines. One example, which is probably a bit historical now that we have Enstilar. See below:

Doctor: Apply this to only the affected regions, three times a day.

Me: I have about 4,500 spots, some of them are on my back. I usually apply this as a moisturizer because I like to leave the house on a daily basis.

Doctor: You shouldn't do that. Apply this to only the affected regions, three times a day.

Me: How am I supposed to do that on my back? I can't reach?

Doctor: You can ask someone to help you.

Me: I live in a shared house, you want me to ask a friend I don't know that well to dedicate 1.5 hours per day to apply ointment to the spots on my back?

Doctor: If it helps, you could reduce this to twice a day. Only on affected areas.

So of course, I applied it like a moisturizer. Another example from a few months ago and to set the scene, I was getting married in 6 weeks and thinking about my psoriasis treatment. I know Dovonex didn't work when I was a kid, but I only know that because my mom told me, I thought I would try it again.

Doctor: You respond well to Dovobet. Enstilar works well, Use this every day twice a day for 4 weeks and then move onto Dovonex to help manage the post-steroid flare.

Me: I usually clear in 6 days on Dovobet. Can I just use it six days before my wedding?

Doctor: Use Enstilar every day, twice a day for 4 weeks, and then move onto Dovonex.

Me: I don't want to use steroids for longer than I need to.

Doctor: Use Enstilar every day, twice a day for 4 weeks, and then move onto Dovonex.

So, of course, I didn't follow his directions, I used Enstilar for 5 days before my wedding on my arms and upper back only. I then failed to use the Dovonex because I was busy and because I have an attitude problem. I should have followed that part of his advice.

Help me out here, doc!

Doctors need to be insured, I get that, but I'm not asking them to go super left field on this. If a patient is sat in front of them, explaining the reasons why they will not be complying with the prescription advice, then the doctor needs to listen and work around that.

Repeating the same information back at a person will not change a person's life circumstances. They won't comply, and there is a great chance they won't say anything at their next appointment. Because why bother bringing this up again?

Doctors also need to be less naive. They may offer a potential solution- like ‘get the housemate you barely know to apply creams to your back three times a day." They will accept that concern as solved as you nod weakly with a resigned acceptance that the discussion is going nowhere. Is that person really going to do that?

Ease your frustrations

Things are improving, the mental health aspect of psoriasis is in my experience being considered more frequently. The advice I was given throughout my twenties with regards to applying creams to only the affected areas is being phased out for some medications.

We now have Enstilar which has the same active ingredient as Dovobet, yet it is sprayed onto the skin, covering all healthy and psoriatic skin.

Frustrated with your doctor?

What are your experiences? Have you received prescription advice that didn't work for you? I would love to know. Let me know in the comments.

And if you're not telling your doctor the truth about how you use your medication, add it to your calendar to tell them at your next appointment. They can help you more if they have a full picture of where you are and what you're doing. There may have been an advancement that will help you.