I’ve worked in the health care industry for over almost 25 years. In that time I have had confirmation time and time again that doctors will take different approaches to treatment of the same condition. I’m sure you’ve heard the saying “don’t be afraid to get a second opinion”, and I wholeheartedly agree with it.
How a doctor treats a condition depends on a number of factors, including when they did their training, where they did their training, how they have kept up to date since completion of their training, their culture, and even the doctors and friends they associate with.
I have seen many studies showing the wide range of treatments provided for the same condition by different doctors. For a non-doctor it is surprising as you’d think that a doctor would use the ‘best’ treatment for a condition, with ‘best’ being that which is most scientifically proven to work. Well unfortunately there are many doctors who are stuck in their old ways, or too stubborn (or lazy – dare I say it) to update themselves to the best methods. When asked why they don’t use what is proven as the best treatment they will make claims such as “everyone is different so no one treatment is best for all”, or “I have been a doctor for X number of years, and I know best”, or “my experience of X number of years is much better than any scientific study” etc. etc. Since the general public are ignorant of studies on treatment outcomes, they typically can’t question the doctor. It is much the same as taking your car to the mechanic – they say the car has a particular problem and needs a particular repair, and you have to take their word for it.
I say to you, as a fellow psoriasis or psoriatic arthritis warrior, if you aren’t getting satisfaction from your doctor, then don’t be afraid to change! Yes, there ARE proven, best methods to treat conditions. Did you know that there is an international organization called Joint Commission, that provides independent certification to hospitals that do follow best practice in treatment of certain conditions? That’s right – not all hospitals follow best practice, and you can find the ones that do follow best practice (outside of the US) here. Within the US a search will show you the hospitals with the best outcomes for treating different diseases.
I have seen studies (usually from the US since they are so advanced in healthcare treatment) comparing treatment outcomes from doctors in the same specialty. The results are eye-opening. I recall one study which followed over 60 orthopedic surgeons in regard to total hip replacement operations. The study took surgeons who had done a minimum of 100 of these surgeries, and compared the use of blood (i.e. patients who need a blood transfusion) during the operation. So these are typical patients who need a hip replacement, and a minimum of 100 operations each surgeon, so you’d expect the results to be similar right? Well at one end a surgeon ordered blood for only 4 of his patients, while another surgeon ordered blood for over 60 of his patients – and an average of 4 units each operation!
Remember, not all doctors are equal!
I’ve had personal experience with this myself, when my psoriatic arthritis was flaring and I wasn’t taking a biologic. In China, I went to one local hospital who called in a “pain specialist”. “Wonderful’, I thought, I will finally get someone who understands my pain and maybe can help me to reduce, or even eliminate it! The pain specialist was a Chinese doctor who had never studied overseas. I was expecting some great Chinese solution to my problem. Their advice? Take a hot bath when I’m feeling sore! I recall that at the time my Internal Medicine doctor was in the same room too – and she had studied in America. She couldn’t hide her shock at such abysmal pain management advice, and had to ask the Chinese “pain specialist” to repeat what she had just said! Of course I had already tried hot baths, as well as massages and anything else which might work. A hot bath did absolutely nothing to relieve the agony from flaring arthritis in my hip and back. I recall waking up about 2am one morning in tears, I was in that much agony. I went through many things trying to get some relief, trying massage, hotwater bottles, anything. Only percocet helped in the end. It was terrible though until it kicked in.
And that leads me to my second experience with pain management – American trained physicians. These guys are EXCELLENT at managing pain. For some reason, they really take pain seriously, and seem to take it as a mission to eradicate it from their patient. They don’t feel they have succeeded until the patient is comfortable. This is quite different from my experience with physicians from New Zealand and Australia who will look at codeine + acetaminophen as some kind of “top shelf” medication, and are extremely reluctant to pull out the big guns when someone is in a lot of pain. They really are difficult to deal with. When I went to an American physician however, they would not hesitate to give me strong medication to deal with the pain, and would follow up to see if it helped!
I recall one time in Thailand when my arthritis was flaring, I went to see a rheumatologist about pain relief. After examining me he gave a pause, looked me in the eye and said, “Ok, I’m going to give you a very very strong pain killer, this is one of the strongest pain killers we have, so I want you to be aware that it is not a normal drug”. Wow, he had my attention. Then he went on “this pain killer is called tramadol…..”. Ha. I still laugh when I remember that. I stopped him there – and told him that I took tramadol for my RLS, and that I had already tried that for my arthritis pain that day and it hadn’t worked – which was why I was seeing him! I said he had to give me something better than that! I hate it how these ‘bad’ doctors then give you the look like you are a “drug seeker”, i.e. addict. Hey doctor – you want to try living in my shoes with my pain for a day? An hour? Be my guest and then see how you cope with someone offering you a hot bath or tramadol to “deal with it”.
Anyway, back to the topic. If you aren’t getting relief from pain, or if you just aren’t satisfied with the treatment you are getting – then please get another opinion! Please don’t ever get depressed if your current treatment isn’t working and think that what your doctor has prescribed is the only way. It isn’t! When it comes to treatment – YOU come first. If your doctor doesn’t meet your needs then change! Come on, if you signed up a personal trainer to help you lose weight and that personal trainer after a decent period didn’t help you lose weight – would you keep paying them? That is crazy. You’d change them pronto (and maybe even try and get some of your money back). The doctor is also in the service industry, and standards in this industry also change from provider to provider. If you aren’t happy with your provider….. well ….. change!Anyway, what got me on to this topic? I recently read a summary of a study into treatment patterns for kids with psoriasis. Apparently how you got treated depended on the type of doctor you saw. Like I said, there are many different methods – so keep looking until you find a doctor who works for YOU.
“A study of more than 3.8 million physician visits for pediatric
psoriasis over the course of 28 years shows important differences in
prescribing patterns, depending on physician specialty and the age of
Dermatologists and internists were most likely to prescribe
high-potency steroids (usually betamethasone), whereas pediatricians
preferred topical tacrolimus.”