MEDICINE IS A SCIENCE BUT ALSO THE ART OF ADJUSTING TO A SPECIFIC, UNIQUE, DIFFERENT PATIENT, THE SCIENTIFIC KNOWLEDGE ACQUIRED BY DEFINITION FROM POPULATIONS.
LIKE FOR ANY ART MEDICAL IT RELIES ON A TECHNIQUE THAT MUST BE LEARNT AND NEEDS TO BE PRACTICED THROUGHOUT A LIFETIME
THIS TECHNIQUE, PRACTICED IN MANY MEDICAL SPECIALTIES, WAS DEVELOPED AROUND A REFLEXION ABOUT PSORIASIS BUT IS ALSO USED FOR ACNE, VITILIGO, ATOPY, VERNEUIL’S DISEASE, T CELL LYMPHOMAS…
IT INVOLVES
MEDICINE CENTRED AROUND THE PATIENT:- IT CONCERNS EVERY CHRONIC DISEASE
- AT THE HEART OF ITS PREOCCUPTATION: THE EVALUATION OF THE SEVERITY OF THE DISEASE AND ITS IMPACT ON THE QUALITY OF LIFE
A RECENT STUDY CONSISTED OF COMMUNICATING A QUESTIONNAIRE TO DERMATOLOGISTS ON THE QUALITY OF LIFE OF PATIENTS COMING OUT OF CONSULTATIONS. AFTER HAVING SEEN THIS QUESTIONNAIRE, OVER 60% OF DERMATOLOGISTS INDICATED THAT IF THE LATTER HAD AVAILABLE BEFORE THE CONSULTATION, THEY WOULD HAVE CHANGED THEIR THERAPEUTIC STRATEGY.
*
IN A EUROPEAN STUDY INVOLVING MORE THAN 23 000 PATIENTS, THE MAIN COMPLAINT WAS THAT THE SEVERITY OF THEIR PSORIASIS WAS NOT TAKEN SUFFICIENTLY INTO ACCOUNT.
The therapeutic strategy must be chosen according to the severity of the
disease and
The physical and psychological tolerance to different treatments.
IRP
THE SEVERITY OF PSORIASIS DEPENDS ON:
1/ THE IMPACT ON THE QUALITY OF LIFE
2/ THE RESISTANCE TO TREATMENTS PRESCRIBED WITH A GOOD STRATEGY
3/ THE EXTENT OF THE LESIONS
IT IS THE SEVERITY OF THE PSORIASIS AND THEREFORE THE
PATIENT’S EXPERIENCE THAT AUTHORISES OR NOT THE
PRESCRIPTION OF SYSTEMIC DRUGS
THE QUALITY OF LIFE AND THE IMPACT OF TREATMENTS ON THE
QUALITY OF LIFE ARE NOT EVALUATED BY THE DOCTOR BUT BY
THE PATIENT
IRP
THEREFORE THE SEVERITY OF THE DISEASE: MAIN
COMPONENT FOR CHOOSING A THERAPEUTIC
STRATEGY,
IS EVALUATED NOT BY THE DOCTOR AS IN EMERGENCY
MEDICINE BUT BY THE PATIENT WITH THE HELP OF
HIS DOCTOR
IN PRACTICE, HOW TO ADAPT IN THE BEST WAY TO A
REQUEST THAT IS OFTEN NOT FORMULATED?
AND OF COURSE, DRUGS THAT CAN BE USED TOPICALLY OR SYSTEMICALLY
IN ISOLATION OR IN ASSOCIATION
IN MOST CHRONIC DISEASES OF THE SKIN, THE MAIN AIM OF THE TREATMENT IS TO IMPROVE
THE QUALITY OF LIFE OF EACH PATIENT.
TO ACHIEVE THIS, THE THERAPEUTIC TOOLS ARE:
QUESTIONSEXPLANATIONS
NEGOCIATION
QUESTIONSQUESTIONS
WHAT IS THE IMPACT OF PSORIASIS ON - PERSONAL?
- FAMILIAL? - SOCIAL?LIFE
WHAT IS THE IMPACT OF PSORIASIS ON MOOD AND BEHAVIOUR?
WHAT IS THE IMPACT OF TREATMENTS THAT HAVE ALREADY BEEN GIVEN TO THIS PATIENT ON HIS OR HER QUALITY OF LIFE?
WHAT IS THE REASON FOR THE CONSULTATION?
1
HOW DOES THE PATIENT EVALUATE THE
EFFICACY OF PREVIOUS THERAPEUTIC
STRATEGIES?
WHAT ARE THE MOST IMPORTANT ASPECTS
OF QUALITY OF LIFE FOR THIS PATIENT?
QUESTIONSQUESTIONS 2
AT THE END OF THESE
QUESTIONS IT OFTEN SEEMS THAT:
A LIMITED PSORIASIS CAN BE VERY SEVERE AND JUSTIFY A MAJOR
TREATMENT
A WIDESPREAD PSORIASIS CAN BE WELL TOLERATED
EXPLANATIONS
THE AIM IS TO MAKE THE DISEASE SOMETHING OBJECTIVE, THAT WE CAN UNDERSTAND AND ON WHICH
WE CAN ACT
EXPLANATIONSEXPLANATIONS
11
ON PSORIASISON PSORIASIS
A CONGENITAL DISEASE
WE CAN THEREFORE NOT PROMISE A PERMANENT CURE BUT WE MUST PROMISE TO IMPROVE THE
QUALITY OF LIFE
WHAT IS THE OPINION OF THE PATIENT ON THE CAUSES OF DISEASE OUTBURSTS?
PSORIASIS IS A NON SPECIFIC REACTION TO EXTERNAL AND INTERNAL AGGRESSIONS
22
EXPLANATIONSEXPLANATIONS ON PSORIASISON PSORIASIS
THE RENEWAL OF THE EPIDERMIS IS CONTROLLED IN ALL HUMANS BY:
* Scratching
* infectious diseases
*weight gain, stopping sporting activities
* alcohol and tobacco
* drugs (treatments for hypertension)
* seasons
* the brain:
any danger signal, immediately or in a delayed manner leads to the acceleration of the renewal of the epidermis
Psoriasis is in itself a danger
THE CONTROL OF THESE FACTORS, WHEN THEY ARE IMPLICATED IS AN IMPORTANT PART OF THE TREATMENT
THE RENEWAL OF THE EPIDERMIS IS STRONGLY ACCELERATED
THE TREATMENT INCLUDES TWO PHASES:
33
A PHASE OF BLEACHING THAT WILL SLOW DOWN THE EPIDERMIS AND WHICH IS EASY TO TRIGGER
A MAINTENANCE PHASE THAT WILL CONTINUE ON AN APPARENTLY NORMAL SKIN AND WILL BE DIFFICULT TO ENSURE
A BLEACHING PHASE
EXPLANATIONSEXPLANATIONS PSORIASISPSORIASIS
A MAINTENANCE PHASE
EXPLANATIONSEXPLANATIONSON THE TREATMENTSON THE TREATMENTS
THE TREATMENT STRATEGY IS AS
IMPORTANT AS THE DRUG THAT IS
USED
11
FOR EACH TREATMENT OR EACH TREATMENT ASSOCIATION YOU MUST EXPLAIN:
THE CONSEQUENCES OF A GOOD THERAPEUTIC STRATEGY ON EVERYDAY LIFE
SIDE EFFECTS
CLINICAL AND BIOLOGICAL SURVEILLANCE
EXPLANATIONSEXPLANATIONSON THE TREATMENTSON THE TREATMENTS
22
SYSTEMIC TREATMENTS ARE VIRTUALLY DANGER-FREE
IF
WE RESPECT THE RULES OF USE
(INDICATIONS, CONTRA-INDICATIONS, SURVEILLANCE)
EXPLANATIONSEXPLANATIONSON THE TREATMENTSON THE TREATMENTS
33
NEGOCIATIONNEGOCIATION
DEPENDING ON THE QUESTIONS
AND EXPLANATIONS
AND THE REACTIONS OF THE PATIENT,
WE MUST NEGOCIATE WITH HIM OR HER
TO CHOSE THE BEST REASONABLE
THERAPEUTIC STRATEGY
Consider with the patient an adaptation of
the treatment baring in the mind the
history, associated diseases, way of life
and character of the patient.
Consider the therapeutic strategy as long-term depending on the available
treatments and therapeutic progresses.
NEGOCIATIONNEGOCIATION
A PART (developing from one consultation to the
next) OF THE THERAPEUTIC CHOICE MUST
BE MADE BY THE PATIENT.
HE MUST LEARN, STEP BY STEP THAT HE
IS CAPABLE OF CONTROLING HIS OWN
PSORIASIS WITH THE HELP OF THE
DOCTOR.
AT THE END OF THE NEGOCIATION, THE PRESCRIPTION IS NEVER JUST A
WRITTEN PRESCRIPTION BUT A CONTRACT THAT MUST IDEALLY BE SIGNED BY THE DOCTOR AND THE
PATIENT
IRP
We cannot treat a chronic disease to the best of
our capacity if the patient does not want to
progressively take control of his disease
This phenomenon of appropriation is different
depending on the education, age, and culture but
remains a condition of observance and
mysteriously of therapeutic efficacy
THE EDUCATION OF THE PATIENT AND THE QUALITY OF THE THERAPEUTIC NEGOCIATION ARE THE KEYS TO THERAPEUTIC SUCCESS.
THIS SUCCESS TAKES TIME (45 MINUTES FOR THE FIRST CONSULTATION) AND REQUIRES A REVOLUTION IN THE BEHAVIOUR OF DOCTORS BUT ALSO PATIENTS.
THE PATIENTS ARE NOT READY, IN MOST CASES, TO TAKE PART IN THE THERAPEUTIC CHOICE.
THE RELATIONSHIP OF A PATIENT WITH HIS DISEASE (AND WITH THE
DOCTOR) CHANGES OVER TIME:
NEGLIGENCE
WORRY
REFUSAL
RESIGNATION
ACTION
The dermatologist must avoid several traps:
1) 1) Over or under estimate the severity of the Over or under estimate the severity of the
diseasedisease
2) 2) Be scared of side effects and not propose Be scared of side effects and not propose
systemic treatmentssystemic treatments
3) 3) Over or under estimate side effectsOver or under estimate side effects..
4) 4) To not take into account the affective To not take into account the affective
relationship between the patient and the relationship between the patient and the
drugsdrugs
THE RHEUMATOLOGIST AND THE DERMATOLOGIST
OUR EMOTIONAL RELATIONSHIPS WITH DRUGS…
AND WITH THE RULES: PRESCRIPTION OUTSIDE OF
MARKET INDICATIONS
Words that are pronounced or unspoken, listened to, heard, are drugs that induce the secretion of several
cytokines and are not devoid of side effects that can sometimes be severe
Top Related