In Combined Clinic, a Rheumatologist & Dermatologist See Patients Together

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Psoriatic arthritis (PsA), scleroderma and lupus often require management input from both rheumatologists and dermatologists. Usually patients see the two specialists separately. Combining both in a single rheumatology/dermatology clinic appointment can improve outcomes and increase both provider and patient satisfaction.

“Physicians talk about tearing down silos of care, where each specialist focuses on their part and does not take into account what other specialties are doing,” says Evan L. Siegel, MD, a rheumatologist at Arthritis and Rheumatism Associates in Rockville, Md., just outside Washington, D.C. “That often doesn’t give the most appropriate form of care.”

2 Disciplines, 1 Time

Dr. Siegel

Having two different disciplines see the same person at the same time allows both physicians and the patient to discuss options in real time. Patients and physicians alike can think about the disease and discuss treatment issues from different angles.

Patients like the one-stop shopping experience of seeing both doctors at the same time without having to run around town or to another part of the office building.

“Patients get to hear the thought processes of both doctors, and it is not infrequent that the therapeutic direction changes,” says Dr. Siegel. “There is an increase in patient satisfaction when they are a part of a decision-making process involving all three parties.”

Lin A. Brown, MD, Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and colleagues presented a poster at the 2014 ACR/ARHP Annual Meeting. They completed a retrospective chart review of patients in their combined clinic. They found these clinics simplified care and increased access. Patients received appropriate treatment sooner.¹

Approximately 20 combined clinics exist in the U.S. Most are in academic medical centers, but there has also been growth in community practices.

Having two different disciplines see the same person at the same time allows both physicians & the patient to discuss options in real time.

Improved Inter-Provider Communications

Joseph F. Merola, MD, MMSc, a rheumatologist and dermatologist at the Brigham and Women’s Hospital in Boston, and others undertook a survey of combined practices as part of a study for the  Psoriasis and Psoriatic Arthritis Clinics Multi­center Advancement Network Consortium (PPACMAN). He and his colleagues found the most common benefits reported were improved communication between providers, training opportunities, and more prompt, accurate diagnosis.²

“Every clinic, I learn a little more about the different skin manifestations of disease, different presentations and mechanisms of treatment that I wouldn’t be exposed to otherwise,” says Dr. Siegel. “The dermatologists learn how to do a joint examination, understand when a joint is swollen or undergoing a bony change and the different kinds of arthritis that can be present in patients with skin concerns.”