Is This Typical for Dermatologists?

Miscellaneous and Personal Stuff I Must Share
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(TMI Warning: If (not too vivid) descriptions of skin rashes gross you out, stop reading now.) I’ll try to make this as short as I can…

About the middle of July, I went swimming with my sister and her kids. In the middle of my application of sunscreen, my 4-year-old nephew pulled a stunt that required my immediate attention. I forgot to go back and finish the job, and as a result, ended the day with a nice sunburn on my shoulders and upper arms. (Plenty stupid of me, I admit, and if you continue reading you’ll see I’ve been amply punished for it, so no lectures, please.)

No big deal, I thought. Wasn’t that bad, it’ll heal in a few days. Alas, three or four days later I break out in a horrific rash. It seems the sunburn has triggered a massive psoriasis outbreak. Now, I’ve had mild psoriasis since I was a teenager. A bad outbreak for me was a small patch on my elbow, maybe a spot or two on my legs or arms. Easily covered up, and it would go away in a few months or weeks, anyway.

This, however, is a whole 'nother kettle of fish. The areas where I was sunburned are a solid mass of red, scaly, itchy skin. My forearms, back of my hands, legs, feet, and upper chest are covered in smaller patches. It’s REALLY bad. I’m embarrassed to go out in public.

So I call my doctor and schedule an appointment. He gives me a dose pack of predisone, with a subscription for a second in case the first one doesn’t do the trick. I end up taking both packs, and they work a little while I’m taking them, but as soon as I start tapering off, the psoriasis comes back full force.

I go back to my doctor for a follow-up, and he tells me I need to see a dermatologist. (Wish he had told me this from the beginning, by now three weeks have gone by while I feel like a leper. I also feel like an idiot for not just doing this myself.) He gives me a name, and I call as soon as I get home. The earliest he can see me is OCTOBER 31st!!! And the nurse tells me I’m lucky to get that, he had a cancellation.

I cannot live like this for that long! I have a wedding to go to on October 25th, that I’ve been losing weight for, was going to buy a nice dress, wanted to look really good in the pictures. I cannot wait.

So, trying not to cry, I call about 10 other dermatologists in the area. I’ve managed to find one that will take me on September 23rd. And now I’m wondering what’s wrong with him that he can take me that early. And why the heck didn’t my doctor tell me I needed to call ASAP the first time I saw him.

This is ridiculous! Do they not reserve time to see people with “emergency” situations? Has anybody else dealt with this? Is there some secret code word I’m supposed to be saying to get an earlier appointment?

Also, as long as we’re here…anybody have any good home remedies for psoriasis?

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It’s not unusual, but you need to be persistent. The secret code word is calling every day and asking if they’ve had a cancellation, and being ready to get there if they’ve had one. Just wear them down.

I have eczema, not psoriasis, so I can’t help you there. But I understand. I had to get a whoppin’ big shot of kenalog before my wedding so I could be seen in public, or else wear a lobster bib over my wedding dress.

Good luck and keep us posted.

3

What a mess! Sorry you’ve had such a hideous reaction!

I actually think it’s reasonable to try to use the primary care doctor as the first step, rather than going to a dermatologist… at least, in this situation where you had every reason to believe that treatment would work.

I’m amazed your lead time to see the dermatologists is such a long one. Do the receptionists who answer the phone know this is a somewhat urgent situation? Any chance you could have your doctor call one of the derms to get you bumped up in priority? It’s hard to imagine they don’t have some leeway built into their schedules to handle unexpected urgent cases!

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They do have space for emergencies, the secret code word is ‘cancer.’ The derm my mom and sister use is the same way, you want an appointment, you have to wait several months. But, my mom has had melenoma. If she calls and mentions anything about an odd wart/frekle/birthmark etc, that’s new or changed, they’ll see her on the same day. They don’t waste time with cancer.

ETA, I’ve always wondered about the long wait time for derms, it does seem pretty common. But I’ve yet to expierence it with other specialties (which luckily doesn’t include many)

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You don’t actually need a dermatologist. Get a prescription for Dovonex from your primary physician. After three or four weeks, you’ll see dramatic improvemnt. It will probably come back eventually, though. I’ve been battling psoriasis for 15 years. You can control it, but you can never get rid of it permanently. Make your peace with it.

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I have psoriasis. It’s more major than what sounds like your mild case. The first time I went to my current derm, he couldn’t see me for about a month. Since then, when I’ve called to make an appointment, I’ve had it happen that when they thought I was a new patient–I was given a month wait. When I did tell them that I was just looking for an appointment to refill meds, etc. I could usually get one in a week/week and a half.

Dovonex is good. I have a topical spray rx for clobetasol/dermazinc that works wonders, especially short term to get it under control.

And home remedy wise? Turmeric capsules from a health food store. I have seen more change per buck from a $ 20 bottle of those capsules than almost anything else. ( I have very large patches and a few capsules a day make an ENORMOUS difference.) I was worried about stomach upset or bad breath or b.o. but that hasn’t happened.

As the first derm I ever went to said: “You have psoriasis. It won’t ever kill you, but it sure isn’t fun. Look! I have some here on my elbow.”

Wishing you good luck!

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In my derm office we have one doctor that books out months in advance, one that probably has a New Patient opening tomorrow or the next day, and the other two are somewhere in between. It really depends on how long they’ve been in practice (how many patients they’ve accumulated) and how popular they are. The doc in our practice that books months out is in the annual list of “100 best doctors in America” so that’s why he’s hard to get into. The one that has very soon openings isn’t a worse doctor than the one that’s hard to get into, he just has a much different patient load.

This is what you can do (and I do suggest you see a derm because there are revolutionary new psoriasis treatments that you should be aware of):

  1. Ask your PCP to call a particular dermatologist and ask that you be seen sooner. Make it easy for him and have the name and number of one for his assistant to call. Doctors will often do these favors for each other as a professional courtesy.

  2. Call yourself and leave a message for the dermatologist or his assistant asking nicely to be “worked in” ASAP. Getting nasty won’t work- trust me on this. They don’t have to work you in soonest, and they really don’t even have to call you back, as you are not their patient, but this tactic has worked many times in the office I work in.

Doctors and their staff are usually just people, and most people don’t want to see someone suffering and actually want to do what they can to help. Make the call (or have your PCP make it).

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Thanks for the replies, everyone.

Sigmagirl, that’s a good idea about calling every day. Not being aggressive when I need to be is definitely a failing of mine. I guess now’s an excellent time to pull myself out of my shell. Who cares if I annoy the nurse, right?

MammaZappa, the nurses definitely know my situation. I was practically begging on the phone. And I did try asking my primary doctor to intervene for me, but got “that’s just how it is, it won’t make any difference if we call,” as a response.

Joey P, okay, yeah…cancer should definitely come before embarrassing rashes. I’m not *that * shallow. :smack:

Diogenes, thanks for the Dovonex recommendation…I’ll definitely be looking into that. Like I said in my OP, I’ve been living with psoriasis for almost 20 years now, so I know it will come back, and I have made my peace with that. But the scale of this outbreak is seriously affecting my quality of life, and I want to at least TRY to do something about it now, not wait for a month and a half to even get started!

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Oh, and no, we don’t actually leave time for emergencies in the schedule. When it’s booked, it’s booked. If you’re squeezed in, you are essentially taking time from other patients that have appointments, and/or the doctor and his staff will start or finish later than they would have. Which is fine, I get paid by the hour- I’m just saying, there’s no open “emergency slots” in the schedule.

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I know, I know. I just remember being amazed (and so was my mom) the first time she called the derm about a new mole or something and she was in the office a few hours later.

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Alice, may I ask why they don’t leave one or two slots open? What about people like Joey P mentioned, who might have something cancerous? Are they always able to be squeezed in?

Also, what do you think of the idea of calling every day to see if there are last minute cancellations? (If I do it in a friendly, polite way, of course.)

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We don’t leave open slots in the schedule on purpose because 1)we have contracts with insurance companies that we will see so many patients a day 2)there are always people calling with emergencies, ALWAYS and 3)I and twenty-something other people in the office enjoy getting paychecks, and our paychecks depend on our schedules being as full as possible. We are in an economic downturn, you know.

The doctor in our practice that has the most patients and is the busiest gets several calls a day from his patients needing to be seen ASAP, and we almost always work them in. Once in a blue moon he will say no and we’ll have to refer his patient to the PCP or Urgent Care but that is rare and when the schedule is so packed it’s not even possible to work someone in. So with such a tight schedule, naturally he’s going to choose to work in his established patients WAY before someone he’s never seen before. Unless their PCP has called, or the patient has called and left a message for The Doctor, not his nurse or assistant, asking to be worked in earlier than soonest available.

Your PCP sounds like kind of a dick for not being willing to do this for you. We have many PCPs that call us to get their patients in sooner- it’s not like it’s unheard of. And it almost always works- doctors like to be nice to each other.

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If it makes you feel any better, I tried to schedule an appoint with six local dermatologists last month.

The earliest available appointment was for April 2009.

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Yeah, that’s typical. I once got told I could be seen by the PA right away though but to see the doctor would take at least 3 months.

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ENTs. Months and months out. And then mine went on maternity leave.

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Come to my ENT. He’s REALLY good, very well respected in the medical community (I do alot of work with doctors and nurses, almost all of them know him and have good opinions of him as well). If I call, I can almost always get in that day. Not only that, but if my appointment is at, say, 2:00, I can get there at 1:45 and be walking back out at 2:00. I almost always get there and get in to see him early.

Now, there is the slight chance he just purposely keeps a light load and perhaps isn’t taking on new patients, I really don’t know.

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If your dermatology department uses Student Interns or Residents, make sure the nurse knows you’re willing to see them. Often their schedules are booked much less chaotically than the physicians. Chances are, if you see one of these and they’re up against something weird, they’ll drag the physican into the exam room to take a peek at you. I’ve had that happen before.

And, be nice to the nurse. They hold your future appointments in the palms of their hands.

Makes note to encourage Hallboy into practicing Dermatology…

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So wouldn’t (2) fill some of (1) ? Or you have to say regular appointments will fill the day?

Shoot, that’s good enough for me. That’s who I see for med checks and basic exams anyway.