Breaking Down Silos: Rheum-Derm Collaboration in Psoriasis Care

"Breaking Down Silos: Rheum-Derm Collaboration in Psoriasis Care" takes up the question of how two specialties can stop working in isolation.

Dr. Han describes how lucky he was early in his career to sit next door to rheumatology. He could ask a colleague to look at a patient and talk through medication choices on the spot. When he wanted to start a therapy, he could pick a rheumatologist's brain about preferences and get the patient seen quickly. He took it for granted until he realized how rare that arrangement is. Many clinicians leave residency and find themselves in a silo, which he links directly to burnout.

Dr. Han offers a concrete path forward. A dermatologist can call a local rheumatology office, introduce themselves as trying to establish a referral network, and offer something in return, such as saving a spot or squeezing in an urgent patient. Building that relationship takes a little effort, but most people are receptive, and patients benefit most of all.

Dr. Wright is an enthusiastic proponent of collaborative care. She values that the two specialties see disease differently, with rheumatologists focused on joints and dermatologists on skin, and she appreciates that difference. She believes in using the phone for more than texting. She will call a colleague or send a photo and ask directly whether a patient needs to be seen and how urgently.

Dr. Wright says sharing cases makes her a better rheumatologist at reading skin and makes her dermatology colleagues sharper at spotting joints. Staying in silos forecloses that learning. She recounts intentionally building a community of providers during her years in academia and private practice, so she could always pick up the phone and get a patient in when an emergency arose.

Our next episode, "Defining On-Treatment Remission in Psoriasis and PsA," turns to the concept driving this whole series, with Dr. Han and Dr. Wright defining what remission should mean on the skin and in the joints.