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What Should I Ask My Physician?


I have said it before and I will continue to say it again, self-diagnosis of rosacea is not a good idea. Physicians, particularly dermatologists, are trained and educated in the art of diagnosis and should be the ones to determine a diagnosis of rosacea. There really are no substitutes. You may want to consult other health care professionals as well for rosacea, but diagnosis of rosacea is reserved for physicians . Please get a diagnosis.

The problems with rosaceans and physicians have become public knowledge posted all over the internet and are listed here for your information and consideration to resolve these issues. It is important to work together with a physician in determining an accurate diagnosis and a personal treatment regimen for your skin problem. What matters need to be identified and resolved? Trusting a physician, communicating with a physician and following up with your physician’s treatment.

Trusting & Communicating with your Physician

A typical initial visit with a dermatologist begins with making an appointment usually weeks in advance, sometimes months. In the meantime, a rosacean (or one who thinks rosacea is the problem or hasn’t a clue what is going on with his/her skin) is reading as much information on rosacea on the internet or by reading this book or other books, asking everyone, trying whatever non prescription , over the counter, products and methods one thinks might work or is suggested by well meaning friends. This sufferer reads about rosacea and has determined that it must be rosacea or it may be possible that the sufferer has no idea what skin condition is the problem. Finally the day arrives to visit the dermatologist. One must wait in the waiting room for what seems like an eternity with other patients who obviously have their own skin issues. You are ushered into an exam room where a nurse or other assistant takes a brief history and may take some vital signs and records everything and your chief complaint. You wait some more. Finally, after what seems like another eternity, the physician enters the room and spends maybe 10 minutes with you, explains to you that you have rosacea, gives you some samples to try, hands you a prescription and tells you to make a follow-up appointment. [1] The physician rushes off to the next exam room. You are left stunned. If this is the first time you have ever heard of rosacea, you are a bit more stunned than those who have read this book. You may no doubt relate to this initial first visit with a physician. Rosaceans who experience this are a bit upset at the lack of patience, empathy and compassion for rosacea patients. It is not to say that all physicians are like this, but this experience of an initial visit is typical. Complaints of the lack of physician empathy for rosacea is common among the various rosacea support groups and forums. There may be several reasons why this happens, but first and foremost is to understand the physician’s point of view. Rosaceans tend to be self-centered, and that is understandable, since after all, we are the ones suffering with rosacea. Rosacea is a very confusing and debilitating disease. It changes your life forever.

Rosaceans come to a physician for comfort, help and treatment and want some compassion, understanding and communication. But wait a minute. Think about it. Remember, we are coming to a physician for help. We need to make it possible for the physician to listen to us, but at the same time we need to keep our minds open to what the physician may tell us. Knowing the physician’s point of view will help you establish better communication, trust and hopefully better treatment. Follow up visits will be better and you will look forward to the visit rather than dreading it.

Becoming a physician is not an easy task. The medical schools make physicians go through some hoops and hurdles that many just simply would not even attempt. Generally speaking, physicians are very dedicated, hard workers and usually have higher IQs than the general public. It would be a mistake to think otherwise, since if this is not true, then we are certainly at a loss. I like to think that physicians who have attained to being a licensed medical doctor are more knowledgeable than me on rosacea. This entitles them to some respect, whether you agree with a physician or not. You can disagree with respect. The two initials behind their name, M.D., gives them the title doctor. It would be wise to recognize, honor and respect their office of appointment as a practitioner of medicine. Rosaceans who treat their docs with disrespect will not get very far with physician treatment. It is important for rosaceans to give their doctor the honor they deserve that goes with the title and this alone will improve communication better than all the other tips on how to win friends and influence doctors.

With the advent of lawyers, physicians have to cover themselves with malpractice insurance that affects patient care since one of the chief concerns of a physician is whether or not it is possible to keep practicing medicine in such a litigious world. You may not think this is important to your care but this affects physician care of a patient. It would be good to understand that it isn’t easy to care for patients when a patient could turn on a physician and bite him. Physicians may be very careful when approaching a new patient who may be a rattlesnake.

Because of the nature of rosacea and psychology (see Chapter 6, Psychology and Rosacea) rosaceans tend to be frustrated, upset, angry, confused, disappointed, depressed, and possibly aggressive. While the physician should be aware of the psychology factor in rosacea, a rosacean needs to understand what the point of view of the physician is on this subject. While one physician understands the psychological factors in rosacea, another physician may dismiss these factors as minimal, which explains the physician’s behavior.

Physicians are usually very busy, with a huge patient load with other patients who are suffering horrible skin conditions, which, by the way may be worse than your rosacea [or whatever skin condition you may suffer]. A physician may prefer to refer a patient with psychological rosacea issues to an expert dealing with such problems, like a psychiatrist or a psychologist.

Find out how his point of view is on this matter if you are feeling upset at a physician’s bed side manner. Besides, the physician has treated rosacea before and for the first visit, this is what is done. Now if you have been to other physicians before, this takes on a whole list of other reasons why it is so important to understand the physician’s point of view on the initial visit. Did you explain to the physician that you have been to another (or possibly other physicians ) for this problem? The physician has a right to know what you have done before coming to him, doesn’t he? The only way to understand what the physician’s point of view (POV) is to ask. For example, you might ask him, ‘Doc, are you really busy today to answer my questions?’

Or how about, ‘Doc, I see that you are in a rush and need to tend to other matters, but could you answer just a few of my questions or would it be better to make an appointment later to help me understand some matters that are important to me?’ If the physician has the time you might want to point out how you are feeling about your rosacea, i.e., the frustration, anger or depression that accompanies rosacea. You might be surprised at what the doctor’s point of view is if you respect his and take into account that a physician has a right to his own point of view. The physician may have more empathy with your point of view if you have empathy for the physician’s POV. When making an appointment with a physician for an initial visit and you want questions answered, it would be good to explain to the one whom you make the appointment with that answers to your questions are important and want sufficient time for the physician to answer your questions. This might go a long way to help the doctor understand your needs. If you present yourself as knowledgeable on the subject of rosacea this can present some problems. After all, the physician has gone to medical school specializing in dermatology and you begin spouting out some rosacea knowledge to the physician, what do you think the physician’s point of view is of you telling him about rosacea? Remember, you came to him for advice, treatment and help? Rosaceans should want to build a good relationship with the physician and presenting yourself as more knowledgeable about rosacea than the physician tends to destroy the relationship considering that you are paying him for his advice, diagnosis, analysis, prescription and treatment.

If you preface a comment about your knowledge of rosacea with, ‘You probably know more about this than I do, but could you answer my question about [whatever]?’ will go a lot further to establishing a good relationship with your physician than belittling a physician or coming across that you know more than the physician about rosacea, which may not be true at all. After all, consider what the physician must know to differentiate rosacea from other skin conditions. The list of rosacea mimics and other skin conditions and diseases that requires a differential diagnosis from rosacea taxes most physicians . To conclude that a physician doesn’t know as much as he should about rosacea is a bit judgmental, wouldn’t you agree? A physician’s job can be at times quite demanding and overwhelming. With the patient load and who knows what else is happening in a physician’s life, if we come across like know-it-alls about rosacea, do you really expect a physician to go along with such disrespect? Maybe a physician prefers to dismiss such a patient quickly and move on to one who appreciates his services more?

“Dermatologists need to ask their patients about their use of all medications including herbs, vitamins and supplements, according to Dr. Wu. “I suggest taking an extra five or 10 minutes to find out what your patients are using on their skin in addition to what you’re prescribing for them.” [2]

Also it is important for the patient to discuss everything with their physician. A NRS survey reveals that "72 percent of patients said that they never discussed the unseen symptoms of rosacea — such as burning, stinging and itching — with their doctor." [4]

Rosaceans should build bridges with their physicians , not tear them down. Usually when a rosacean visits a physician it is because everything else simply doesn’t work. It is the last resort, sort of like when one visits the dentist. So, instead of concentrating on what you think the physician should do, try to listen to his suggestions. The physician may be right.

During the initial visit you should explain to the physician what other treatments you may be doing for your rosacea, i.e., natural treatments, over the counter products, herbal remedies, vitamins , supplements, diet, whatever. It is very important to explain to your physician if you have visited any other physician for rosacea before visiting him. The physician has a right to know what you have done for your rosacea before seeing him.

“Due to the fact that many patients fail to inform their physicians about their use of herbal ingredients, dermatologists should be aware of what patients may be using and be able to advise them about the efficacy of these ingredients or the potential for adverse effects.” [3] This is especially true when you consider the synergistic effect of multiple treatments for rosacea. You physician deserves to know what you are currently doing to control your rosacea, even if it hasn’t been working. He may advise you to stop all other treatment and follow his treatment regimen or may explain that what you are doing is just fine and to continue it. But the physician needs to know.

Follow up Visits

Basically, whatever the physician suggests you do, usually a follow up visit is made. That is why the physician asks you to set up an appointment before you leave the office. This is done to follow up whether the treatment suggested is working. Why? Because not all treatments work for every rosacean. (See Appendix X—X Factor [Rosacea 101 book])

You have to be the judge whether to continue a treatment suggested if it is making your rosacea worse. There are some treatments for rosacea that initially make matters worse before it gets better, i.e., Soolantra. You should ask your physician whether or not the treatment he is suggesting will make it worse before it gets better so you will know what to expect. However, if it continues to get worse, you will have to be the judge as to when to stop the treatment and report back to the physician at the follow up visit what exactly happened. The follow up visit may include new treatment to follow. This is not unusual for a rosacean to receive several treatment regimens before finding one that controls your rosacea.

Finding a Physician

Finding a physician who is knowledgeable with rosacea and has a record of happy rosacea patients is the dream of all rosaceans who use physicians to treat their rosacea. Many of the forums and rosacea support groups offer suggestions or recommendations of physicians they have used and some report whom not to use. Word of mouth has always been the best source of whether a physician is recommended.

RX Treatments for Rosacea

Understanding Diagnosis of Rosacea

It would be good to also understand what is involved in diagnosing rosacea. Click here for a report on this subject.

You may want to print the following published paper and bring this with you to your dermatologist to give him a copy: 

Forum for Nord Derm Ven 2017, Vol. 22, No. 1
Rosacea: Time for a New Approach • Rosacea-Time-for-a-New-Approach.pdf

An educational supplement published in DermatologyTimes sponsored by Galderma, Best_Practices_in_the_Treatment_of_Rosacea.pdf, is another article for your consideration. 



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There is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post?  And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register?  We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.  

End Notes

[1] For anecdotal reports of a five minute or less diagnosis of rosacea click here.

[2] Herbal therapy for rosacea Some herbs help, others hinder patient’s condition By: Jane Schwanke, Dermatology Times, Nov 1, 2006

[3] J Drugs Dermatol. 2006 Jan;5(1):29-32.
Treatment of rosacea with herbal ingredients.
Wu J: J Drugs Dermatol. 2006 Jan;5(1):29-32.

[4] Survey Reveals Gaps in Doctor-Patient Communication, NRS
Posted: 07/30/2018

[5] Rosacea: Beyond the visible



David Pascoe has an article, Make your Doctor a Rosacea Expert, which is related to this subject.

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