It’s fairly common to hear eczema patients lamenting that their doctors seem to be just prescribing creams and not listening enough. It can be even more difficult for parents, particularly as we are not the one ‘experiencing’ the eczema but we’ve got the responsibility to learn as much from the doctor (while keeping our toddler quiet)! MarcieMom is privileged to know Dr Susan J. Huang, the chief resident at the Harvard Dermatology Residency Program, who works at multiple prestigious hospitals in the United States.
More on Dr Susan J. Huang – Dr Huang is the chief resident of Harvard Dermatology Residency Program, and works at many hospitals including the Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Childrens’ Hospital of Boston, Boston VA Medical Centers, and the Lahey Clinic. She is also the author of DermBytes.com, an online resource and blog on dermatology. Dr. Huang has written book chapters, published peer-reviewed articles, and presented at multiple national conferences on issues and topics in dermatology.
Marcie Mom: Thank you Dr Huang for last week’s tips on during consultation, this week we are focusing on after the consultation when the parent is now to manage and treat the child’s eczema, as advised by the doctor.
A common scenario is that he/she would be doing all as told, but find that the child is still scratching incessantly (and sometimes, with blood and tears daily)! Eczema is a chronic condition to be managed and parent shouldn’t be expecting miraculously smooth skin just because a doctor has been consulted. However, under what circumstances would it be justified to call the doctor before the next consultation?
Dr Susan Huang: Hopefully, the physician has talked about what to expect from treatment during the visit. As you said, eczema is indeed a chronic condition and does not go away overnight. Setting expectations for the short term and long term period is a good idea at every visit. However, if there are any questions after you go home, you should feel comfortable calling the doctor’s office to get those questions answered and to see whether you need a visit to the office sooner.
MarcieMom: As advised by Prof Hugo, I bring my child for swimming and chlorhexidine-d her regularly, to reduce the staph bacteria. Lately, after learning more about nutrition from Toby Amidor and Julie Daniluk, I also feed my toddler with more anti-inflammation food and flaxseed oil. I know that there is no conclusive study on nutrition’s impact on eczema, but can and should a doctor advice outside of standard treatment options to include lifestyle and nutrition?
Dr Susan Huang: While we often think of pills and medications when we think about the practice of medicine, medicine really is much more. There are many lifestyle practices that can help in eczema and learning about these practices is helpful. Bleach baths, wraps, use of emollients are all treatments that are behavioral and can help in eczema. It is always a good idea to ensure good nutrition for all patients as well.
MarcieMom: Some eczema patients do feedback that their doctors don’t seem interested to listen to what the parents have to say regarding the child’s skin and eczema. It may truly be the case but does a parent have to be mindful to share what’s relevant to the doctor? For instance, is it possible that parents worry too much and discuss too many (remote) triggers? What is a clear sign of a disinterested doctor or one that shows no empathy for eczema?
Dr Susan Huang: It is important to have a good relationship with your child’s eczema doctors since eczema is a chronic disease. This patient/parent-doctor relationship will be one that extend beyond the initial visit! Every patient/parent-doctor relationship is different and the dynamics of the conversation of each visit depends on this relationship as well. If you find that there is difficulty in communication, you should find a doctor with whom you feel comfortable communicating with.
MarcieMom: Suppose a parent has found another doctor and wishes to stop seeing the current one. What should he/she ‘take-away’ from this doctor to the next? For instance, asking for the client-file? Does that belong to the hospital/doctor or to the patient? Also, I know that if a child is prescribed oral steroid, the follow-up consultations by the same doctor is important to assess the follow-up treatment options (and also completing the course as prescribed) Should a parent stick to the same doctor till the oral steroid course is over? (Do read my toddler’s positive experience with oral steroid)
Dr Susan Huang: It is helpful for your new doctor to know what evaluation has been done (including any lab tests, allergy tests) and what treatments have been tried. This way, you won’t “reinvent the wheel.”
In the United States, patients can request a copy of their medical files. This can be done through the doctor’s office, or if you are in a larger hospital, you may need to go through the medical records department.
Since eczema is a chronic disease, it is helpful for the doctor to get a sense of what the course of the disease has been and what the response to a certain treatment has been (whether it is oral steroids or another treatment). This is often easier if it is the same doctor, but sometimes that is not possible. If it is not possible to stick with the same doctor, make sure to have the documents pertaining to your child’s care. Photos can help as well.
Thanks Dr Huang, it has been a very helpful 3 weeks and I’m sure many parents will find this series helpful; My take is no matter what, don’t forget to enjoy our children with eczema (despite the eczema)!
For previous posts in this series, see