Coordinating Care Between Your Rheumatologist and Dermatologist
During rheumatology training, we had a special clinic called the “Rheum-Derm” clinic. Once a month, rheumatologists and dermatologists would huddle together in the same office space to put our heads together on mutual patients. It was helpful to see the dermatologists’ point of view on conditions like lupus, psoriatic arthritis, and dermatomyositis during that shared time together. I saw that although we have access to the same treatments and biologics, the approach to using those medications can be quite different between specialties.
Fast forward to being alone in private practice after medical training, I see that the challenges of teamwork and coordinating care with other specialists is even greater. The gap between different branches of medicine can be quite wide, and my patients often lament that they feel like they are seeing too many different specialists and none of their doctors are really communicating with each other. Here are a few reasons why a fragmentation of care could be occurring.
Different training approaches
Rheumatologists are often trained to use DMARD medications first, such as methotrexate, leflunomide, or sulfasalazine. Our first-line medications are often older medications that have been shown to have efficacy for reducing joint pain, swelling, rash, and other manifestations of autoimmune disease. On the other hand, dermatologists may be more likely to skip the DMARD tablets and go straight to an injectable biologic for treatment of plaque psoriasis and other conditions. They might feel that the biologics are a better fit for their patients.
Different areas of focus
It probably goes without saying that each specialty prioritizes its own body system. Rheumatologists are more concerned with reduction of joint pain, stiffness, and swelling and other musculoskeletal symptoms, whereas dermatologists are more concerned with reducing the body surface area that is affected by certain rashes. Certain treatments may have more of an advantage in reducing the joint symptoms, but have less of an effect on the skin. The opposite is also true—some medications really reduce the severity of the skin rash but don’t help as much with joint pain and swelling. It can be a struggle at times to find the right treatment that offers the right balance between living with less pain and also with clear skin!
Sometimes my patients can be confused because they don’t know whether they are supposed to be following up with both their rheumatologist and dermatologist, or just one out of the two. It can get confusing who is prescribing their medications or sending refills. Clerical issues can occur, such as sharing lab results or clinical notes between two different offices.
Rheumatologists and dermatologists work best together when they are within the same hospital system, share the same electronic medical record, and can see each other’s clinical notes and lab results in the computer. I consider myself lucky because the dermatologist I work with is just down the hall and it’s very easy to talk to her about mutual patients and refer new patients to her if I’m not sure what a rash really is. Being in close proximity with a dermatologist that I trust and share the same philosophy with definitely facilitates better care for my patients. Finding a rheumatologist and dermatologist who work well together, share the same approaches, and communicate easily with one another will lead to better patient outcomes and satisfaction.