When dr's dont agree on treatment

What do I do when 3 doctors will not agree on method of treatment? My Rhemy wants to start me on Enbrel. Right now I am on MTX… He does not want me to take that drug at all… The dermatologist would like for me to stay on it for at least a few months.

Who do I listen to?

Well, then I had to get a new PCP… that doesnt really know my history… and she wont sign off on the standing order… for the blood work necessary to stay on the MTX… im frustrated… because … the dang insurance company requires blood work to go thru the doctor clinic to be ok… for the co-pay… otherwise you have to meet the deductible, etc… etc. you all probably know the drill… geez… when I did see the PCP last week she made me feel rushed… she was rude and obtrusive…

I will be looking for another dr… I do know that… but does anyone have any suggestions about the Rheumy and the Dermatologist…??



Good question, Karen. I'd blow off the PCP as she doesn't know your history. Can you get your rheumatologist and dermatologist to consult with each other? It might take you going to one or the other medical offices and waiting until you get satisfaction. Start with whichever doctor is most responsive to you. Tell them you need their assistance and they need to consult with your other treating physician to find a treatment plan that suits both MDs and also meets YOUR needs. Good luck. Managing your healthcare is a really tough row to hoe!

Sure is. Ty sooo much. I was sooo mad at PCP that I forgot to get Tb test done yesterday. I wonder if I need to have that done at Dr. Office or if I can go to pharmacist

My rheumatologist did the TB test. I'm from England and the type of vaccine we got as kids almost always shows a false positive with a skin test so he did a blood test. When are you back to the rheumatologist?

I've been thinking more about your dilemma and it seems that the rheumatologist should be taking the lead--(s)he is the one with expertise in this area. The derm's first expertise is in P. The rheumatologist's area is PSA. Sure there's overlap in both directions, but the rheumatologist ought to be better up to date on PSA treatent than the derm--although consulting with each other is a great way to move forward. The derm should be expressing his/her ideas to the rheumatologist and (s)he sould be factoring that into a treatment plan--ALONG WITH YOUR CONCERNS. It seems you can leave the PCP out of this all together.

If you do need to see the PCP for other things, be sure to cross check with your rheumatologist about drug interactions. I recently had a sinus infection (common for me) and ordinarily I call my PCP for a Z-pak. Well, this time I called the rheumatologist and they were VERY helpfull and VERY responsive and, as it turns out, Z-pak would have been an AWFUL idea (V. bad for liver with MTX). Rheumatologist prescribed antibiotics that wouldn't undo the MTX and I was able to keep on my meds while taking the antibiotics. For me the rheumatologist is now the "go-to" guy. Everyone else plays a supporting role. But I trust my guy and I like his nurse and staff lot.

OK--that's MORE than enough!! Happy Thanksgiving!