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Therapy management

This is a strategy in four stages:

The first is that of questioning. This allows one to apprehend the individual unique context, in which the illness is expressed. It is the foundation of what is called the global approach, in which the doctor’s attention, following the diagnostic phase centred on the illness, focuses on the patient, on his relations with himself, with his illness and with his treatment. Little by little, one consultation at a time, this dialogue allows the illness to be objectivized, to make it into something one can act upon, not something merely to be endured. The illness becomes an event that doctor and patient alike are able to ponder and work on.

The second stage is that of explanations. We explain to the patient the mechanisms of his illness, what is known about its development and treatment. Together with the patient, we examine any links there may be between what is known of the physiopathology of the illness and his way of life, as well as the ways in which the various treatments available can or cannot be adopted to his day-to-day life. This second stage will allow the patient to understand how he himself can act on the illness, that drugs are there to help him, but cannot substitute him in finding a good quality of life, and that, in some way, he has the wherewithal to master his illness with the help of his doctor.

These two initial stages (the so-called global approach) are enlightened, though not limited by the scientific medicine. The aim of this global, individualized approach is to introduce the third and most important stage, that of therapeutic negotiation. Good negotiations are conducted between two people, each having a different point of view in the true sense, both being informed and in a position of equality, seeking together to find the best possible compromise to resolve a problem. The quality of therapeutic negotiation between doctor and patient will therefore depend on the quality of the first two stages. Through these, the doctor will come to an understanding of the patient’s life pattern and can try to argue from within this set-up. This will enabled the patient to better understand his illness and better understand the various potentials and constraints of the therapeutic tools at his disposal. He gains the ability to personalize this information by relating it to his own situation, to his own way of life, to his own perception of values. From one consultation to the next, he understands that he is acquiring the freedom to take control of his illness.

Hence, between a variety of technically sound possible therapeutic strategies, the negotiation will end in a choice made by or with the patient. This takes us onto the final stage, that of the prescription. In this context, it is by no means a medical prescription, but a contract that concludes the negotiations and, ideally, should be signed by doctor and patient alike.