Psound Bytes™ Transcript: Episode 186

Release date: February 2, 2023

“Welcome to this episode of Psound Bytes™, a podcast series produced by the National Psoriasis Foundation, the nation’s leading organization for individuals living with psoriasis and psoriatic arthritis. In each episode someone who lives with psoriatic disease, a loved one or an expert will share insights with you on living well. If you like what you hear today, please subscribe to our podcast and join us every month at Psound Bytes™ for more insights on understanding, managing, and thriving with psoriasis and psoriatic arthritis.”

Shiva: My name is Shiva Mozaffarian, Programs Promotion and Outreach Manager at the National Psoriasis Foundation and today I come to you with a question - have you ever wished you were more prepared for an appointment with your health care provider more then you were?  If you answered yes, you’re in luck.  I’m here to discuss what you can do to prepare and make the most of your health care appointments with certified physician assistant Kirk Gautier from US Dermatology Partners in Tyler. He also works in Athens, Texas and sees numerous patients daily addressing severity and treatment of psoriasis and other diseases of the skin, hair and nails. He’s known for his compassion and his tireless efforts to make sure the needs of his patients are met. Let’s hear what tips Kirk can provide around preparing for your appointments.

Welcome, Kirk and thank you so much for being here with us today. So as a healthcare provider what do think the overall purpose for having appointment is and how active of a role do you feel patients should take in their health care?

Kirk Gautier: It's nice to be here. Thank you for having me. The appointment is actually to establish a legal agreement between a patient and a provider so they can actually be treated. So I can't just see somebody on the street and grab them and say you're going to be my patient. I'm going to treat you and take biopsies and everything like that. There's consent. There's different things we need to do. So part of just establishing an appointment is actually to legally, make you a patient of mine or some other healthcare provider. So initially the appointment is the meet, greet, diagnose and treat. You can kind of think of it as the who, what, when, where, why and how of the appointment. It's really very important to understand who I am taking care of. Now subsequent appointments can just be to see how our journey is going, what has changed, what is working, what is not, what's fitting into your lifestyle and what is not possible. There are learning, teaching points at every single appointment. I learn from my patients and I share anything new in the literature or from conferences that I might have heard or read and then I listen because I learn so much from my patients. I need to be able to tell them what makes them better and they teach me what makes them better or worse and it's really a mutual sharing of information. There are also some little annoying things in questions I gotta say that come up we've been mandated to do. Please don't get offended at the nurse for asking some things about hey, do you smoke? Do you feel safe in the home? Just know that your nurse is asking these questions because the provider is telling them because administration is telling us to collect some kind of measurable data. I'm sorry it's irritating, troublesome, bothersome. But it's a new part of the medical record that we all have to record.

Shiva: With that in mind, what can a new patient do to help make that first appointment go smoothly?

Kirk Gautier: So of course, be on time for your appointment with updated health insurance information. And I would honestly wear some loose-fitting clothing. I have to see skin to make a diagnosis. Now is really not the time to be modest. And this might be embarrassing but basic hygiene is a good thing. I need to know what meds and supplements as well as other topicals, any product history that you're using, anything that you're using to your skin right now or have used in the past month or two is very helpful. History of prior skin cancers, your past medical history. Do I need access to your medical records? Maybe there's some forms you need to fill out and bring them with you. And I will say it does seem to be a theme in medical offices when I request medical records, until the patient gets involved, nothing seems to get done. So, it’s very helpful if you take an active role in making sure that I'm able to see your past medical records.

Shiva: You mentioned  being aware of treatments. What exactly should be on the treatments list?

Kirk Gautier: Well, what kind of topical lotions, potions, solutions, injections have you done? Have you tried? What's worked? What's not? Is there anything that seems to help you, hurt you? I need to know are you using other kind of maybe herbal medicines, some kind of holistic practices. It all ties in and helps me as a provider be able to help you as a patient.

Shiva: In general, what should a patient bring to every appointment? Should they bring their prescription bottles or containers to every appointment?

Kirk Gautier: It is nice to be able to see what patients are taking and how much they're using. Sometimes people think that, hey, I have this one prescription of this tube and I expected it to last them a week and they've stretched it out somehow to a month and still have half of the bottle left. So that is nice to be able to actually clarify how much product people are using, but without any doubt an updated medication list with the time, the route and the amount they're taking.  Like I said before, updated insurance information is always beneficial and you know honestly with the current plethora of wonderful options that we have, I really need to have our patients bring a sense of hope and happiness because we're seeing more success in psoriasis treatment than we ever have in history.

Shiva:  It’s so true. There are a lot of options available now. So, one thing the National Psoriasis Foundation recommends is that patients with serious disease keep a symptom tracker or journal to share with their health care provider to help identify top concerns. What do you feel would be of benefit to include in this journal to help assess with what the needs are?

Kirk Gautier: Well it's very interesting. Psoriasis can wax and wane over time. I think patients will be surprised on how much stress plays a role in their flares. There's an app by the National Psoriasis Foundation called Twill, where patients can find community. They can find somebody who is able to sympathize with them because of their own struggles. Now, as a provider, I can see that you might rate your symptoms an 8 out of a 10. And these symptoms are exacerbated by certain things, and that's helpful.  Most people are going to be avoiding those things, and my goal is to try to help you learn new things to avoid and to try to help you in things in ways that you haven't thought of or maybe that your Twill community hasn't thought of. I believe the paperwork of the tracker offers some validation for patients however they still really need to feel and express how impactful some particular sign or symptom is bothering them. They can show me, hey, you know what? This is the worst thing in the world, but patients typically are going to also wanna show me and that's OK. I don't want the log to get in the way of the appointment and get in the way of the patient being able to really express to me in their own words how they feel. When I have somebody who is doing really good. I tell you what happens, this happened today. I walk in the room, they're completely dressed, just sitting back, happy like they have nothing to discuss. If somebody is not where they wanna be, they've got the pant leg rolled up, the shirt sleeve is up. The top is off and they're ready to show me those things and address these other conditions. So maybe the log is going to help patients remember how some get better and some symptoms get worse over time.

Shiva: So is it helpful for patients to make a list of other health conditions or diseases they have, along with contact information for the healthcare providers who manage those conditions, say like an endocrinologist or rheumatologist?

Kirk Gautier: Oh, for sure. Maybe you have seen somebody recently who told the patient that they had gout or maybe plantar fasciitis or osteoarthritis. Maybe somebody's going to a chiropractor, or a holistic healer that just says, well, you needed more adjustments for your back pain. These actually could just be signs and symptoms of psoriatic arthritis that are being misdiagnosed. So a list of provider names and numbers can be extremely helpful. I might be friends with them or know them personally, and that makes a world of difference in how quickly communication can be transmitted with permission. Maybe I need to clear a therapy or drug with them or other possibilities that just need to be checked out with your other provider, make sure that those treatments are OK with what they're doing. And honestly, in my opinion, this is the way medicine should work. We used to as providers be able to get together at a hospital for dinners very frequently. We could chat about patients and what was good and what was bad, what was working, what was not. But now we're all so spread out that what used to be typical conversation and shaking of hands and mentioning some challenging cases that experience sharing is just now fractured.

Shiva: Yeah, collaborative care can definitely be an issue. What questions should someone ask if you're recommending a new treatment option?

Kirk Gautier: So this is something that seems to separate providers and patients. Patients would really like to know how efficacious something is, and providers really wanna know how safe something is. Maybe it's a legal, ethical battle but typically, and I'm sure it's not always true, we really want the best of both worlds, right? So while I really want the most efficacious and the safest medication sometimes those don't line up. Usually they do, but sometimes it ends up coming down to availability and possibility. What can be covered? What's the cost? How is this patient going to be able to give this medication? Is it something they can put on, something they can't? And unfortunately, we don't have a cure for psoriatic disease. So everything is going to be continued until we reach either a side effect or a lack of efficacy or availability. So one thing patients need to know is, you know, you don't need to ask how long will it take or do this. Patients need to know the timing of a medication, the amount of the medication, how it fits into their lifestyle, what you should do or should not mix with the medication. Any kind of side effect that should be expected or what kind of side effect warrants a call to the provider's office and might be an emergency. So I'm happy to answer all the questions that the patients have when they wanna know about a new treatment option. Sometimes I might recommend something though, that just unfortunately is not going to be available for them. In a perfect world, we would all have the best treatments. Sometimes it's just not the way it goes, and it's very unfortunate.

Shiva: And given COVID many clinical practices utilized telehealth to see their patients. Is preparation for a telehealth appointment different from an in-office appointment?

Kirk Gautier: You know, not much really. I would say, just to avoid some kind of embarrassment, make sure the patient kind of picks up around themselves to avoid any kind of embarrassing situations. Don't show anything in your home that you wouldn't want to be brought into our office. Lighting, extremely important. Extremely important to have good lighting so the image that you're trying to convey that we can see that, as well as a strong Internet connection and not to mention the steady hand while you are trying to share the images that you need someone else to see.

Shiva: Time limitations are probably one of the biggest factors with healthcare appointments. What can patients do to help maximize their time with you as a health care provider?

Kirk Gautier: So using the symptom tracker that is provided by the National Psoriasis Foundation There's a one 800 number there. You can call that, it can be mailed to you and it's just a weekly a weekly tracker that helps you identify your own flares so you know personally what to avoid and how to help yourself. It can help you narrow down your top concern during the appointment and just making sure that number one stays #1. Now other concerns need to be addressed as well. It's impossible to address every concern, right. Especially if you come dressed in like a three-piece suit, then you take 10 minutes to undress. So back to my earlier statement, if you can wear some kind of loose-fitting clothing that's really beneficial. So bring your top concerns, be able to be undressed or be able to show your main concerns quickly and easily. And if you have any kind of stories you want to share, just be aware that they need to be pertinent and kind of relevant to the appointment that day.

Shiva: So Kirk, should patients be upfront about their health concerns and fear of side effects, or if they feel they can't follow a treatment plan to reach the identified goal?

Kirk Gautier: Well, this is going to be a very short answer - yes. Why waste any time or money on something that either cannot or will not be used or any kind of treatment plan that can’t be followed because of fear or finances. So please make your fears known. While I'm there, while you are there with me as a provider, I'm gonna be the best person that’s going to be able to discuss these issues with you. If you leave the office and try to call back, you’re gonna have to navigate our phone system and then get to a nurse who he or she is not gonna have the same experience or expertise that your provider will be able to offer you while you are in the office for your appointment.

Shiva: Great point. And how important is it to have a treatment goal in psoriatic disease?

Kirk Gautier:  This is probably one of the toughest questions because any goal that we have should be reasonable. I mean, my ultimate goal is to find out what starts psoriasis. How can we stop it permanently? That's my goal. But I'm not a researcher, so I I can't achieve my goal. I can do my best with the available treatments and technologies to help the patients achieve their goal. Hopefully. Patients have to understand, though, that things like the spots where psoriasis was, the hyperpigmentation, the dark spots, man that might take years to go away. And joint destruction is not fixable if your finger is twisted, is knarled. Nobody's gonna be able to fix that. So we have to somehow measure these goals with some kind of humility. We're all getting older and all we can do is to try to extend the health of our years and our goals can change. I have patients that don't care about some of their psoriasis as long as it doesn't itch. And I have other patients that are single and then get into a relationship and now their intimate areas where they might have some psoriasis become extremely important. And unfortunately, again, not all of the best psoriasis treatments or universally available or are safest for everybody at every time. So goals are important, but goals also need to be individualized and with the understanding that they might change over time.

Shiva: What recommendations or tips can you offer to help ensure patients follow a treatment plan provided at an appointment?

Kirk Gautier: Well, have you ever heard of the dental floss effect? So right after we see our dentist or right maybe before we see our dentist, we're more likely to brush, we're more likely to floss, we're more likely to take better care of our teeth. This works in dermatology also. So initially appointments need to be a little bit closer together. We can benefit from this with having some checks and balances and knowing where patients are getting some feedback, knowing that they're following the routine or their treatment plan because patients are thinking about it more often. You just left your appointment. You've got another appointment coming up. Even if a patient sets a reminder on their phone to continue their medications two weeks after their appointment, it can be empowering to a patient to remember to not give up. Now some companies have nurse advocates, and nurses that are associated with their products that will call and they will check on patients to see if they were following through with their treatment plan. And this has literally been studied and shown to be beneficial. Since not everybody has that, it can be beneficial for patients to have some kind of an advocate for them. That could be a family member, it could be somebody they met on a social media app, it could be somebody that they know, that is suffering with their same condition. So patients need an advocate to help them stay connected to their treatment and a collaborator so they can meet their treatment goals.

Shiva: We know that cost or access to treatment due to limited income may impact someone's ability to follow a treatment plan. What tips can you offer to help people access the treatment they need?

Kirk Gautier: If somebody has a financial hardship that they need to discuss, this is not an inappropriate place to do it. Let me, tell you a story real quickly. I have a patient who was completely covered in psoriasis, like 80% .  It was red, some of the worst psoriasis I've ever seen. OK. He is an orphaned, illegal Latino who happens to be deaf, mute without the ability to write and he doesn't know sign language. All right, now I would tell you our first appointment together was very challenging. I speak a little Spanish. I knew he was Spanish. I thought I was talking to the guy. I thought I was communicating and then come to find out I was absolutely impossible to communicate with him. But he is on a medication now, that is keeping his psoriasis controlled. I think sometimes people suffer for longer than they need, believing that because maybe they don't have insurance, or they don't have the finances that their medications are not an option. There are numerous companies that have assistance programs, and while not everyone will qualify, there might be other options or other pharmacies that we can use. Not all pharmacies charge the same when it comes to medications. And there are some older, less expensive medications that might require more monitoring and some different side effects that we have to be aware of. Maybe some lifestyle modifications. But it is completely appropriate for you to please talk to your provider about what they can and can't do, what they can and can't afford. Some of the newer things, some of the fancier things, unfortunately of course, are some of the more expensive things. But the older things that we have, it's not that they don't work, they can work and they can work very well. It just takes more energy, effort, maybe some more time, and more monitoring. So please let your provider know any kind of impact that it's going to make to your lifestyle. 

Shiva: Thank you Kirk for being today and for sharing the very wise and useful recommendations you provided. In closing, what do you feel are the benefits of being prepared for healthcare appointments? Do you have any final comments you'd like to share with our listeners?

Kirk Gautier: Well, thank you for letting me be here. Being prepared for your appointment should make your experience and your provider’s experience both better. I enjoy helping patients more that actually come prepared and respect my time as I try to respect theirs and help them achieve their optimal health goals. Please remember the loose clothing thing, basic skin hygiene. I don't have X-ray vision. And as far as I know, none of my colleagues do either. And so I'm gonna miss 100% of the rashes, of the skin cancers and everything that I can't see.  And your dermatology exam time is not a time for modesty. OK. The only other thing that comes to mind is avoid Dr. Tik Tok or Instagram. Please don't search out medical advice on some of these sites. I see the craziest things and the advice that comes out of them. I had a lady who was told just the other day that her SSRI, her antidepressant depressant was causing low vitamin D so she started taking vitamin D. She had all these vague complaints. And guess what? She was actually toxic with vitamin D because what she was told is just not a thing. Please go to reputable sources for information like the National Psoriasis Foundation and if anybody's in Tyler, TX and needs a provider, I am there with US Dermatology Partners and be happy to help anybody that I can. 

Shiva: Thank you again Kirk for being here with us today! I’m sure the information you provided will help those who have psoriatic disease be more proactive in their health care appointments. For a free copy of the “Flare Guide and Weekly Symptom Tracker” that Kirk mentioned or to learn more about how to “Take an Active Role in Your Health Care” contact our Patient Navigation Center by emailing at education@psoriasis.org or by calling (800) 723-9166, option 1 today. And finally thank you to our sponsors who provided support on behalf of this Psound Bytes™ episode through unrestricted educational grants from Bristol Myers Squibb, Janssen and UCB. 

We hope you enjoyed this episode of Psound Bytes™ for people with psoriasis and psoriatic arthritis. If you or someone you love has ever struggled with psoriatic disease, our hope is that through this series you’ll gain information to help you lead a healthier life and inspire you to look to the future. Please join us for another inspiring podcast. You can find this or all future episodes of Psound Bytes™ on Apple Podcasts, Spotify, iHeart Radio, Google Play, Gaana, and the National Psoriasis Foundation web page. To learn more about this topic or others please visit psoriasis.org or contact us with your questions or comments by email at podcast@psoriasis.org.  

This transcript has been created by a computer and edited by an NPF Volunteer.