Collaborative Management of Atopic Dermatitis - Episode 4

Advice on Collaborative Care for Atopic Dermatitis

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Peter A. Lio, MD: It’s important to me to work with our primary care physicians as closely as possible. I have a wonderful network in the Chicago area where people feel comfortable that they can call me or send me a message and say, “We have a tough case. Can you help?” Sometimes it may just be a “curbside consult” over the telephone, and we can talk through it a little. Other times I’m going to say, “You know what, send them in. I’ll get them in this week.” I think it’s so important to create those kinds of connections.

When that’s not possible, if there’s not someone local or not someone who has that rapport established, it will be so nice to be able to create national networks or even international networks of experts who are there to help support and give some backup for these difficult cases. That’s part of the initiatives that are happening right now. But we still have a long way to go.

I always tell primary care practitioners who call me or message me about a patient, I always remind them that they should never feel embarrassed. They should never feel sheepish about doing it. The truth is, as dermatologists we are, in a way, a primary care specialty. Many patients come in off the street and they have a spot they want to ask about or just want a skin screening. We do screening, for better or for worse. It is not my favorite part of my job—I’m a little more interested in focusing on patients with problems that are causing a lot of trouble—but it’s an inevitable part of our job. People say, “I’ve heard you. I should get my skin checked. Will you look me over head to toe?” I remind them that there’s no stupid consult. There are no dumb questions. Send them in if there’s a concern. The way we can do it best is if they can give us a little information, because sometimes they don’t really need us to see the patients. Sometimes it’s more of a question such as, “Is this appropriate?” or “Do I need to send them to you?” If we can help with that triage, that can relieve a lot anxiety and also really help the quality of those referrals.

A big part of our problem is, how do we organize all this information? How do we keep this all in our heads? That’s part of the work of the National Eczema Association. If we look at their website and we sign up and get our patients to sign up, that is a way that can help take that fire hose of information and bring it down into a just-in-time distribution that also has incredible access for patients online with information, support groups—some that support network that’s so important are often missing. We see so many families who feel utterly alone with this condition, and it’s bizarre because as soon as I walk out of that room, I go into another room with another family feeling totally alone. But I want to say, “Can you guys just hang out? You really are in the same boat; you’re not alone. This is a common issue.”

We’re trying to find ways to connect people, hopefully through technology and through good people who are interested and motivated to help. We are going to connect people together.

Transcript Edited for Clarity