I Am a 60 Year Old Man?

Referrals to new doctors are nerve-wracking.

I’d considered various scenarios, and thought I was ready for anything, however, I hadn’t expected the nurse who roomed me to ask, “When were you first diagnosed with psoriasis?”

Puzzled, I looked at her and said, “I’ve never  been diagnosed with psoriasis.  My doctor said this rash might  be psoriasis, but he wasn’t sure.”

The nurse raised her eyebrows and eyed me like I was clueless.  Then she showed me the charge slip that the doctor would complete and pointed out the lone word “psoriasis” on the “reason for visit” line.  In my book, that only means that the person who scheduled the appointment made a mistake.  Words like “possible” and “suspected” would easily have fit in the allotted space, but were omitted.  Since I’m  not the one who did the data entry, I can hardly be blamed for the error.  And, while I suspect that I might have psoriasis, there are a few pretty good arguments against it.  That’s why a doctor does the diagnosing instead of the patient.

Not a good start to the appointment, but not the end of the world.  When the doctor came in, I was surprised to discover that he’d already looked at my paperwork.  I was slightly off-balance from the nurse thinking I had a definite diagnosis.  For some reason, I thought the referral was straightforward, so didn’t anticipate the doctor asking, “What can I do for you today?”

A few options rushed through my head:

  • doesn’t the referral form say what you’re supposed to do?
  • I’d love to have you tell me that I don’t have discoid lupus
  • tell me that this isn’t scleroderma, either
  • convince me that I definitely don’t have psoriasis, which means I don’t have PsA, which means my daughter doesn’t have PsA

Not knowing anything about this dermatologist, I silently repeated my new-doctor mantra:  “Don’t come on too strong; start off slowly; build trust,” and finally asked, “Can you help me get rid of this rash?”

How frustrating that patients aren’t supposed to have any ideas.  What a waste of time that so many doctors find it annoying for patients to have done any research.  I’d have loved to say, “These weird coin-shaped things all over my body are driving me crazy, and whatever is going on with my scalp is driving my husband crazy (because I keep scratching them).  I don’t think I have discoid lupus, because even though the shape and size are right, the location is wrong.  Despite Raynauds and peripheral neuropathy, I don’t think it’s scleroderma because my SCL-70 antibodies were low last time that test was run.  Whatever these coin-shaped things are, I think there’s something else going on too, because I also had a different rash that looked exactly like photos I’ve seen of inverse psoriasis (but it disappeared with one application of the steroid cream, so you can’t see it).  Is it possible to have psoriasis with no scales anywhere, and also have this completely unrelated rash, too?”  But apparently patients who do online research are annoying, so I kept all those thoughts to myself.

After looking at this odd rash, the doctor declared that it’s not psoriasis.  Neither is the stuff on my scalp.  He looked a little puzzled, and said, “It looks like nummular dermatitis.”

Who Gets Nummular Dermatitis?
This skin problem is more common in men than in women. Men tend to have their first outbreak between 55 and 65 years of age. Women are more likely to get it between the ages of 15 and 25 years.

Ah, now I know why he looked puzzled.  Time to do some research, make a list of questions, and hope it doesn’t annoy this new doctor that I want to understand what’s going on.  My first question will be, why do I have something that’s not common in my age group or gender?

I now have a topical steroid cream, steroid ointment, steroid solution, and am desperately feeling the need for another cortisone injection in my shoulder.  I think I’d rather just go back on prednisone – which, in addition to making my joints feel better, should clear up this rash.  Unfortunately, I think I need to know this doctor a lot longer before I can just ask if pred is an option.  I sincerely hope that I never again need another new doctor.

Ambivalence

Preparing to see a new doctor is frustrating.  In addition to filling out mountains of paperwork, I have to guess which aspects of my medical history the doctor will deem important.

Will he want copies of any of my prior lab work?  Which of those tests might matter?

Will he want my guesses about what’s going on, or should I keep my thoughts to myself unless asked?

Will he want to know about discontinued medications as well as current meds?  He should, since two or three of them are pertinent to the situation.  What if he doesn’t ask?  If he does, will he want exact doses/dates, or just the med name and approximate dates?

How I long for the days when I had only one doctor and saw him only for my physicals & the kids’ well-child visits.  I liked going in for a routine check-up and being told, “You’re healthy.  Come back in two years.”

Alas, those days are gone.  While I’m thankful that people have selected medicine as a career, and I’m grateful to my physicians for their help, I am weary of needing to see doctors.

So very weary.  I’m tempted to cancel my upcoming appointment with yet another specialist.  If it weren’t for the threat of getting a “non-compliant” label, I never would have scheduled the appointment.  On the other hand, what would be the point in asking my doctors for their expert help and then ignoring their recommendation?

Some days I find myself asking, “What did I ever do to deserve this?  Why does my immune system hate me?”  Then I cancel my little pity-party and get back to figuring out how to cope with this situation.

I want this appointment to go well, so I need to be prepared (unless I call the whole thing off, in which case I need to be prepared to explain that choice to the referring doctor).  Although I don’t want to go, I probably should.  To that end, in addition to gathering information, I’m reviewing some of the things I’ve learned in the past few years about doctor-patient interactions.  It feels like I’m cramming for a test:

know why you’ve been referred (Dr. Grumpy)

remember that doctors are human, too (Jill of All Trades)

small-talk matters (Dr. Synonymous)

ask, “what else could it be?”  (Groopman)

provide the information doctors need (Medical Interview)

Letter to Patients With Chronic Disease

There’s certainly more, but with any luck, this will get me off to a good start with this new doctor.

Patient Perspective on Refills

Med renewal appointments are supposed to be quick.  How hard can it be to verify that everything is okay, then write a new prescription?

Although I’d love to have my pharmacy fax my doctor about my prescriptions, doctors want to periodically examine the patient before authorizing more refills.  It doesn’t take very long reading medblogs to realize that there’s a reason my doctor won’t okay refills over the phone (or fax).  Maybe something has changed and the dose needs to be tweaked.  Maybe the medicine isn’t effective, so a different one needs to be tried.  Medblogs are great for learning the reasons that doctors offices do some of the things they do.

It’s one thing to read about it in theory, it’s another to experience it.

At a recent appointment, I asked for a renewal on two prescriptions.  Simple, straightforward.  That was the whole purpose of the appointment; I figured it would take five minutes.

One medicine is a headache prophylactic that I’ve taken for three years.  As usual, my doctor asked about headaches.  Normally I say there have been none, then he writes the renewal.  This time, however, I mentioned that I’d been having headaches, but figured out that it was due to the muscle relaxant I’d been taking.  I quit taking it, and have had no headaches since then.

While this was good news in obtaining a renewal on that med, it threw a wrench in the works for the other medicine that I wanted more of.

That second medicine was to treat a rash.  That rash was thought to be from a medication interaction.  If you start taking a new medication and subsequently develop a rash, then it makes sense that the med might have caused the rash (especially when it’s listed as one of the med’s possible side effects).  It also makes sense that discontinuing that med would make the rash go away.  If you discontinue the med, but the rash continues to get worse, then maybe the rash was caused by something else.

I knew that, but I don’t care.   I don’t care what the rash is.  I don’t want to know.  I don’t want to go to more doctor’s appointments.  I don’t want to have more tests.  I don’t want to incur more expense.  I don’t want another diagnosis.  I am done!  All I wanted was for my doctor to write a prescription so I could refill my meds (so that I can have little round scars on my legs instead of ugly bleeding sores).

Apparently, good doctors care what a rash is, even when the patient would rather not know.  I don’t want to go to more doctor’s appointments – but I have a referral and the appointment is already scheduled.  I don’t want to have more tests – but the doctor will probably want to run some.  I don’t want to incur more medical expenses – but all of this is going to cost money.  I don’t want another diagnosis – but it looks like I’ll walk out of there with one anyway.

Last week I checked in at my FP‘s office expecting my doctor to renew two prescriptions in a very quick appointment.  He did write those prescriptions, but that half-hour appointment wasn’t quick.  This is incredibly frustrating.  Request for med renewals aren’t supposed to be snowball appointments.