Finding a New Provider
Recently I made the hard choice to switch dermatologists. You know what? It felt like breaking up with a girlfriend. I put the records request in thinking that would give them the hint, but then a few months later I got the call—asking why I hadn’t made another appointment. Boy, oh boy, was that awkward. I had to face the music and explain that I had found someone else.
All joking aside, it really was an experience I hope I don’t have to go through again for a long time. When you have psoriasis, especially as severe as I have, your dermatologist becomes almost like a primary care giver. I have to see them every few months, get bloodwork, and once a year go through the dreaded full-body exam. I have never been to prison, but I imagine cavity searches are akin to melanoma checks.
Taking charge of my health
So, as you can see, it takes a lot for me to go through the stress of changing doctors. Unfortunately, in this case, it was necessary. I waffled with writing about this for a while now because I didn’t want it to come off as a griping session. I finally decided to write on this topic after talking to others with psoriasis who are stuck with providers that are either under treating them, or not supporting them enough. If you are in that same place today, please hear me---you do not have to settle!
A little background on my switch, since I am sure I have you all curious now. I felt that I wasn’t working within a partnership. That is how your healthcare experience should be—a team approach. My initial biologic, a TNF inhibitor, failed me so it was time to go on to what was next. My provider recommended another older drug, because that is what her protocol (still not sure where the protocol came from) called for. By this point I was feeling pretty dejected about the failing of my first biologic, so I wanted to shoot for the stars to decrease my chance of another failure. If I was going to try another medicine, I wanted it to be the one with the highest success in clinical studies for the most people, which at that time was an IL-17 biologic.
My former derm was pretty straightforward from the beginning that she was not comfortable with that idea, because she only had one other client on the medicine, but I continued to stand firm. So she moved ahead and passed the request to her support staff to get insurance approval. Insurance (no surprise) came back and said they wanted me to go through step therapy. From there on out I got minimal support for my needs. The support staff would call me and say “I don’t know why you just don’t go with what the insurance wants you to do.” They also would consistently delay the appeals process and I was reliant on sample medications from the manufacturer for months.
As you can imagine, this all left a bad taste in my mouth. I was able to finally get the medicine I fought for, but it was only because the company that made the drug had a new program to help those who were dealing with insurance barriers. I have now been clear for nearly a year. Had I not fought so hard, I may not have been able to say that.
Again, I am not telling you this story to stir up disdain or dissatisfaction. Dermatologists and their staff can’t be experts on every single disease. The point I want to emphasize is that you should never feel you have to stay on a treatment or with a provider that is not helping your health. Your health is crucial for you to have a fulfilling life, and sometimes you have to fight for that.
How to go about it
If you are in a position where it is time to make the switch, there are a few options. The first thing you can do is ask around. I found my new dermatologist—who is AMAZING, by the way—by asking for recommendations from my family and friends. If your family and friends can’t refer you, or you want to vet their endorsements, the National Psoriasis Foundation’s Patient Navigation Center is a great place to find a psoriasis specialist. They have a comprehensive list of providers that are committed to psoriatic disease patients. This is really important. There are a lot of dermatologists who specialize in aesthetic medicine, and it can be hard to find the right fit some times.
Another roadblock you may be coming up against is that you live in a rural area. I lived in the middle of nowhere for 5 years, so I can appreciate how hard it is. Often times there is only one doctor. This is where teledermatology can be a great option. This is an up-and-coming way to be able to have access to a broader range of specialists. I have used this option once (my insurance provides a doctors "on demand app"), and I really can’t say enough great things about it. I was able to take a picture of the area of concern and then talk face to face via my phone’s camera with the provider. This also is a great option when you are flaring severely. Often times my skin would be so cracked that I didn’t like to expose my open wounds to the public, especially the germs that hang out in medical offices.
If my story resonates with you, and you feel it is time to find a new provider, don’t feel guilty. Trust your instincts and listen to your body. After all, it is the only body you have! You deserve a provider team that values your health as much as you do.
Do you like to go pswimming with psoriasis?