It is understood that this new therapeutic approach, which takes on different shapes in different medical specialities, fits particularly well any chronic disease. Its purpose is, by means of a literal revolution in the doctor-patient relationship, to restore liberty to the patient in the face of the relative incarceration engineered by his illness, and to which the doctor occasionally contributes. Particularly in skin disorders, the deterioration of the self-image has often a serious effect on all social relations, and patients feel very keenly this plight of imprisonment inside a distorted image of themselves. But this largely transcends the bounds of dermatology; any illness impairing an organ destabilizes a life based on relationships. And even if the organ requires obviously to be taken care of, the relationship also needs to be nursed in return. This cannot be done without the active and informed, and hence accountable, participation of the patient: no one can be liberated against his will. With this approach, there are naturally far fewer compliance problems, since the patient has been able to take hold of his illness, to regain control of it.
For thousands of years, medicine has only had the patient as target, empathy as treatment and fate as companion. The development of evidence-based medicine and more and more outstanding therapeutic tools has focused everyone’s attention on the illness, and on diagnostic and therapeutic tools of exceptional effectiveness. More particularly, this progress has made it possible to discover the role of the nervous system (and hence of the emotions) in controlling immune, inflammation, growth and cellular differentiation responses in numerous organs. It is only natural, then, that organ-based medicine centring on the fight against illness and disease should rediscover the patient in his or her individuality. This realization should be the starting point for a much more efficient and status-enhancing division of tasks between specialists and GP en route to a system of global management in which the patient, not the illness, is put at the centre. The very advance in evidence-based medicine therefore emphasizes the urgent need to put in place techniques whereby general knowledge can be applied to a particular individual as best as possible, thus encouraging the development of what we call patient-based medicine.
Is this new approach simply a restatement of medical humanism? On no account! It is a matter of medical techniques that are needed for the effective management of all chronic illnesses, whatever the nature of the doctor, whatever his or her ability to show empathy, and whatever the patient’s wish for dependence. These techniques can and must be taught, and the artificial distinction between technician doctor and humanist doctor should merge amid global approach techniques. Today’s doctor must make use of all scientific knowledge available in databases, drawing from his experience and integrating the patient’s life pattern in order to help the latter to choose whatever means will allow him to find his indivisibly physical and mental balance. It is interesting to note that more and more often patients are attending consultations armed with plentiful documentation about their illness obtained over the Internet. The request is clearly worded: “Here’s what I’ve been able to find out about my illness and treatment for it, and I’ve come to discuss it with you, doctor”. Today’s patient lines up directly at the third stage, the negotiating stage, what does not exempt the doctor from going back over to the first two stages with him again, rather on the contrary, but allows a much greater avail.
Is such management possible? Under the current conditions for practising medicine, the answer is no. In fact, these techniques take time, and medical time is absolutely not valued these days. If management of chronic illness is to be improved, it is paramount to take spent time into account and to allow every doctor, one day or half a day a week, to bill for his consultation, not on the number of consultations but on the basis of spent time. Needless to say, this will not increase health costs in any way, since the ‘takings’ for this particular day or half-day will remain unchanged.
Does this management alter the way medicine is taught? It is already beginning to do so: an initial endeavour, called patients-partners, originating in rheumatology, consists of having small groups of students meeting patients who have accepted special teaching. These encounters are designed to heighten students’ awareness of managing not only the illness, but also the patient in every aspect.
Yet, it is doubtlessly in postgraduate medical training where this revolution in care strategy will have the greatest impact. It is effectively a matter of elaborating new training techniques whereby classic lecture-based teaching, in which an expert comes to teach practitioners, can be supplemented with a totally different approach. Practitioners are asked to tell others about hands-on management situations. Each situation is presented during the postgraduate training session, and each person suggests different management solutions, providing reasoning for them through the information presented and gathered thanks to the technique of global approach to the patient. The conclusion is delivered by the practitioner, who explains what management he has selected, for what reasons, and what the results were. This postgraduate training technique allows medical education to be developed not only for the illness but also for the patient. The first trials based on this new approach are already under way.
Through this new initiative, the patient becomes once again the owner of his illness and hence of his medical records, taking the responsibility for his health on his own shoulders. Does patient-based medicine whittle down medical power? I do not believe so, quite the contrary. By developing patients’ knowledge and freedom, medical power recovers its true meaning: that of taking care of an equal. By gradually becoming technically useless as the patient frees himself from his illness, the doctor becomes humanly indispensable.
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- 2018/07/16SPIN Symposium at the Spring continental meeting - Tehran, 25-27 April 2018
- 2018/02/222nd National Meeting of the Egyptian Society for Psoriasis
- 2018/02/211st Psoriasis Symposium - Sarajevo 2017
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News from medical groups
- 2018/04/183rd Turkish National Psoriasis Symposium
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- 2017/06/21Costa Rica Psoriasis Group - Meet them!
- 2017/02/02Works of the 1st Senegalese Psoriasis Day published!
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News from patients associations
- 2017/02/08France Psoriasis - 2016 World Psoriasis Day
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- 2015/04/09AEPSO Argentina launches digital map to find people with psoriasis in the country
Recent publications on Psoriasis and Atopic Dermatitis
Integrated analysis of gene expression profiles identifies transcription factors potentially involved in psoriasis pathogenesis.
J. Cell. Biochem.. 2019 Aug , 120, (8):12582-12594.
Psoriasis is a common inflammatory skin disease mediated by cells and molecules in both the innate and adaptive immune systems. Recently, gene expression profile analysis revealed a large set of immune-related differentially expressed genes (DEGs) in psoriasis. However, the associations between these DEGs and their transcriptional regulation mechanisms have not been completely elucidated. In this study, several psoriasis Gene Expression Omnibus data sets were systematically analyzed using (...)see on pubmed
Models of human psoriasis: Zebrafish the newly appointed player.
Dev. Comp. Immunol.. 2019 Aug , 97:76-87.
Psoriasis is a human chronic, immune disease with severe cutaneous and systemic manifestations. Its prevalence, among the world population, highly varies with ethnicity and geography, but not sex from remarkable low levels in Asia to 2.3% in Spain, or an impressive 11.5% in Norway. The pathogenesis of psoriasis derives from complex genetic and environmental interactions, which creates aberrant crosstalk between keratinocytes and variated immune cell, resulting in open amplified inflammatory (...)see on pubmed
A vivid cytokines interaction model on psoriasis with the effect of impulse biologic (TNF-α inhibitor) therapy.
J. Theor. Biol.. 2019 Aug 07, 474:63-77.
Psoriasis is a chronic skin condition that produces plaques of condensed, scaling skin due to excessively rapid proliferation of keratinocytes. During the disease progression, keratinocyte proliferation is influenced by many immune cells and cytokines. This article deals with a five dimensional deterministic model, which has been derived using quasi-steady-state approximation for describing the dynamics of psoriasis in various cytokines environment. Equilibrium analysis of the system shows (...)see on pubmed
Prenatal perfluorooctanoic acid exposure is associated with early onset atopic dermatitis in 5-year-old children.
Chemosphere. 2019 Sep , 231:25-31.
Atopic dermatitis (AD) is the most common childhood skin disease and the first step of atopic march. Perfluoroalkyl substance (PFAS) exposure is associated with atopic diseases, including AD. However, whether PFAS exposure is related to earlier AD onset remains unclear. We aimed to investigate the association between prenatal PFAS exposure and earlier onset of AD in children in a 5-year follow-up study. From 2001 to 2005, 1264 mother-infant pairs were recruited from eight Taiwanese (...)see on pubmed
Synthesis of chitosan derivatives with organoselenium and organosulfur compounds: Characterization, antimicrobial properties and application as biomaterials.
Carbohydr Polym. 2019 Sep 01, 219:240-250.
In this study, Schiff bases of chitosan (CS) were synthesized using citronellal, citral, and their derivatives containing selenium and sulfur. Organoselenium and organosulfur compounds show attractive biological and pharmaceutical activities, which can be beneficial to CS-based materials. From the characterization analyses, it was found that the CS-derivatives containing organoselenium and organosulfur compounds exhibited the highest conversion degrees (23 and 28%). Biological assays were (...)see on pubmed
Effect of cinnamamides on atopic dermatitis through regulation of IL-4 in CD4 cells.
J Enzyme Inhib Med Chem. 2019 Dec , 34, (1):613-619.
This study aimed to evaluate the effects of cinnamamides on atopic dermatitis (AD) and the mechanisms underlying these effects. To this end, the actions of two cinnamamides, (E)-3-(4-hydroxyphenyl)-N-phenylethyl acrylamide (NCT) and N-trans-coumaroyltyramine (NCPA), were determined on AD by orally administering them to mice. Oral administration of the cinnamamides ameliorated the increase in epidermal and dermal thickness as well as mast cell infiltration. Cinnamamides suppressed serum (...)see on pubmed