sample_data/psoriasis_study/GP_01_Suburban_Practice.txt

Interview Transcript - General Practitioner #1
Date: October 20, 2025
Interviewee Type: HCP (General Practitioner)
Location: Suburban Family Practice, Minneapolis, MN
Years in Practice: 22 years
Specialty: Family Medicine
Psoriasis Patient Volume: ~50 patients with psoriasis (mild to moderate)

Interview Content:

Interviewer: Thank you for meeting with us. Can you describe your practice and how you manage psoriasis patients?

HCP: I'm in a suburban family practice with three other physicians and two nurse practitioners. We see all ages, from newborns to elderly patients. Psoriasis is not my specialty, but I do see it fairly regularly - maybe 50 patients on my panel have some degree of psoriasis. Most are mild cases that I manage with topical steroids and emollients. "For moderate-to-severe cases, I refer to dermatology. I'm not comfortable managing biologics in primary care."

Interviewer: What makes you uncomfortable with biologics?

HCP: A few things. First, I don't have the specialized training. I learned about biologics in residency, but that was 20 years ago, and there are so many new ones now. Second, the monitoring requirements - I'd need to do regular lab work, watch for infections, know what adverse events to look for. "As a family physician, I'm already managing diabetes, hypertension, COPD, depression. Adding complex biologic management on top of that feels like too much." It's safer to refer to someone who does this every day.

Interviewer: Do you prescribe any systemic therapies for psoriasis?

HCP: Very rarely. I've used methotrexate a handful of times for patients who couldn't get in to see dermatology quickly. But even that makes me nervous because of the liver toxicity and teratogenicity. I follow the protocols - baseline labs, monthly monitoring - but I'm always relieved when the patient finally gets to dermatology and I can hand off that management.

Interviewer: Have you heard of Dermovia?

HCP: The name sounds familiar. Is that one of the newer biologics for psoriasis?

Interviewer: Yes, it's an IL-17 inhibitor that launched about 18 months ago. It's dosed every 12 weeks.

HCP: Okay, yes. I might have seen drug reps mention it. "But honestly, I don't spend much time learning about psoriasis biologics because I don't prescribe them. If a patient has severe psoriasis, I refer to dermatology, and the dermatologist decides what medication to use."

Interviewer: Do you have patients who are on Dermovia or other biologics prescribed by dermatology?

HCP: Probably, but I might not always know the details. When I get consultation notes from dermatology, they'll say "started on biologic therapy" or list the specific drug name, but unless I'm actively managing a side effect or complication, I don't delve into it. "My role becomes more about coordination of care - making sure the patient is getting their labs done, following up on their preventive health, managing their other chronic conditions."

Interviewer: How often do you refer patients to dermatology for psoriasis?

HCP: I'd say I refer maybe 10-15 psoriasis patients a year. The referral criteria are usually: extensive body surface area involvement - more than 10%, I'd say; failure of topical therapies after 2-3 months; involvement of face, hands, feet, or genitals where it's really impacting quality of life; or patient request. "If a patient says, 'This psoriasis is ruining my life, I need to see a specialist,' I'm not going to make them wait."

Interviewer: What's the typical wait time to see dermatology in your area?

HCP: It depends on the practice. Some of the big academic centers have 2-3 month wait times. The private practice dermatologists might be 4-6 weeks. "There's one dermatologist who takes same-week appointments, but he's an hour away, so it's not convenient for most of my patients." The wait can be frustrating for patients, especially if they're suffering.

Interviewer: Do you do anything to bridge that gap while patients are waiting?

HCP: Yes, I'll prescribe potent topical steroids, sometimes a short course of oral prednisone if they're really flaring. I'll counsel them on moisturizing, avoiding triggers like stress and alcohol. "But I'm very clear that this is temporary relief until they can see the specialist. I'm not trying to fully manage their psoriasis in primary care."

Interviewer: Have you had patients whose psoriasis was successfully managed by dermatology with biologics?

HCP: Oh, absolutely. I've had patients come back after starting a biologic and their skin is completely clear. It's remarkable. "I have one patient, a 45-year-old woman, who'd had terrible psoriasis for years - arms, legs, torso covered in plaques. Dermatology started her on some biologic - I don't remember which one - and within three months, her skin was 90% clear. She was overjoyed." That's when I'm really glad I referred her.

Interviewer: Do you ever manage side effects or complications from biologics?

HCP: Occasionally. If a patient on a biologic develops an upper respiratory infection or UTI, I'll treat that in my office. I'll prescribe antibiotics, tell them to monitor for worsening, and notify their dermatologist if it's not improving. "I had one patient who developed thrush while on a biologic. I treated with fluconazole and called the dermatologist to let them know. They adjusted the biologic regimen." It's a team approach.

Interviewer: What about preventive care for patients on biologics?

HCP: That's definitely in my wheelhouse. I make sure patients are up to date on vaccinations - flu, pneumonia, shingles, COVID. I'm cautious about live vaccines in immunosuppressed patients, so I'll coordinate with dermatology on timing. "I also counsel patients about infection prevention - hand washing, avoiding sick contacts, seeking care early if they develop symptoms." My role is to keep them healthy overall while dermatology manages the psoriasis.

Interviewer: Do you screen patients for comorbidities associated with psoriasis?

HCP: Yes, that's something I'm very mindful of. Psoriasis is associated with metabolic syndrome, cardiovascular disease, diabetes, depression. "I make sure patients with psoriasis get regular blood pressure checks, lipid panels, glucose screening. I ask about mood and sleep. If I find any of these issues, I manage them or refer to appropriate specialists." Psoriasis isn't just a skin disease - it's systemic.

Interviewer: How do you counsel patients about the chronic nature of psoriasis?

HCP: I explain that psoriasis is a lifelong condition that waxes and wanes. There's no cure, but there are treatments that can control it very effectively. "I say, 'This is like diabetes or hypertension - it's something we manage long-term. With the right treatment, you can have clear skin and a normal quality of life.'" I try to be encouraging while also being realistic.

Interviewer: Do patients ever resist referral to dermatology?

HCP: Sometimes, yes. The reasons vary. Some can't afford the copay for a specialist visit. Some don't think their psoriasis is "bad enough" to warrant a specialist. Some just don't want to add another doctor to their roster. "I try to educate them on the benefits of specialist care, especially if their psoriasis is significantly affecting their quality of life. But ultimately, it's their decision."

Interviewer: Have you had patients who couldn't access dermatology due to insurance or cost?

HCP: Yes, unfortunately. I have patients with high-deductible plans who can't afford the $200-300 specialist copay. I have Medicaid patients who struggle to find a dermatologist who accepts Medicaid. "In those cases, I do my best with what I have - prescribe generic topical steroids, counsel on lifestyle modifications, maybe try methotrexate if I feel comfortable. But it's not ideal. They deserve specialist care."

Interviewer: What would make you more comfortable prescribing biologics in primary care?

HCP: A few things. First, better training - maybe CME courses or online modules specifically for primary care physicians on biologic management. Second, clear protocols and decision support tools - like an algorithm that says, 'If A, then B.' Third, easier access to specialist consultation. "If I could easily call or message a dermatologist with questions, I'd feel more confident. But as it stands, I don't have that support, so I refer."

Interviewer: Are there any systemic psoriasis treatments you'd feel comfortable prescribing?

HCP: Maybe the oral medications like apremilast or deucravacitinib. Those seem less intimidating than injectables. If there were clear prescribing guidelines and monitoring protocols for primary care, I might consider it. "But I'd still want dermatology backup. I'd want to know I could pick up the phone and ask, 'Hey, my patient on apremilast is having diarrhea, is this normal or do I need to stop the drug?'"

Interviewer: How do you stay updated on psoriasis treatments?

HCP: Mostly through CME conferences, medical journals, and drug reps. "I'm honest, I don't seek out psoriasis-specific education because it's not a major part of my practice. But when I go to a family medicine conference and there's a session on dermatology, I'll attend." I get the basics, but I'm not going to be on the cutting edge like a dermatologist would be.

Interviewer: Do drug reps provide useful information about biologics?

HCP: Sometimes. They're obviously biased toward their product, so I take what they say with a grain of salt. But they do provide educational materials - patient handouts, dosing charts, insurance resources. "If a rep comes in and explains how their biologic works and what the side effects are, that's useful context. But I'm still not going to prescribe it without specialist involvement."

Interviewer: Have you had patients who self-advocated for specific biologics they saw advertised?

HCP: Oh, all the time. Patients see TV commercials for psoriasis drugs and come in saying, "I want to try that one." I explain that biologic selection is complex and depends on many factors - disease severity, insurance coverage, patient comorbidities. "I'll say, 'That might be a great option for you, and I'm happy to refer you to dermatology to discuss it. But that decision is best made with a specialist.'" Most patients understand.

Interviewer: What's your overall impression of the current psoriasis treatment landscape?

HCP: From my vantage point, it seems like there are incredible treatments available now. The biologics are dramatically effective - patients go from covered in plaques to clear skin. "The challenge is access. Not every patient can see a dermatologist quickly, afford the medications, get insurance approval. So there's a gap between what's possible and what's actually accessible." That's frustrating for patients and for me.

Interviewer: If a patient asked you about Dermovia specifically, how would you respond?

HCP: I'd say, "I'm not familiar with the specifics of that medication, but I know it's a biologic for psoriasis. Let me refer you to dermatology, and they can discuss whether Dermovia is the right choice for you." "I'd never pretend to have expertise I don't have. Honesty and appropriate referral are better than trying to manage something beyond my scope."

Interviewer: What role do you think primary care should play in psoriasis management?

HCP: I think we're well-suited for managing mild psoriasis with topicals, screening for comorbidities, providing preventive care, and coordinating with specialists. "For moderate-to-severe psoriasis, especially cases requiring biologics, dermatologists should lead. But primary care is the hub of the patient's overall health, so we play a supporting role - making sure vaccines are up to date, managing infections, addressing comorbid conditions like diabetes and depression."

Interviewer: Have you seen psoriasis treatment evolve over your 22 years in practice?

HCP: Absolutely. When I started, the options were pretty limited - topical steroids, UV light therapy, methotrexate, maybe cyclosporine. The biologics have been a game-changer. "I've watched patients go from 'I've learned to live with it' to 'My skin is completely clear for the first time in decades.' That's incredible progress." The next step is making sure everyone who needs these treatments can access them.

Interviewer: Any final thoughts on psoriasis management in primary care?

HCP: Just that primary care physicians need better education and support if we're going to play a larger role in systemic psoriasis treatment. Right now, the model is 'refer to dermatology,' which works but creates access bottlenecks. "If there were ways to empower primary care to manage uncomplicated psoriasis cases with appropriate specialist backup, we could probably improve access. But that would require training, protocols, and collaboration." It's worth exploring.

Interviewer: Thank you so much for your time and insights.

HCP: You're welcome. I hope this perspective from primary care is helpful.