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.
- 2019/10/29 Focus on...World Psoriasis Day 2019
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News from the web office
- 2017/06/05PIN becomes SPIN - Skin Inflammation & Psoriasis International Network
- 2016/10/29PSO 2016 Congress - Webcasts Available!
- 2016/05/26PIN Survey on Phototherapy
- 2016/02/20PIN Study on Therapeutic Patient Education
- 2016/02/19World Directory of Psoriasis Medical Resources - February 2016 Update
- 2019/04/18 Focus on...SPIN Congress 2019 in Paris coming soon
- 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
- 2017/06/2815th São Paulo Meeting of Psoriasis and Vitiligo
News from medical groups
- 2018/04/183rd Turkish National Psoriasis Symposium
- 2017/06/21Brazilian Center for Psoriasis Studies joins SPIN!
- 2017/06/21Costa Rica Psoriasis Group - Meet them!
- 2017/02/02Works of the 1st Senegalese Psoriasis Day published!
- 2016/07/29Swiss S1 Guidelines for Systemic treatment of psoriasis vulgaris
News from patients associations
- 2017/02/08France Psoriasis - 2016 World Psoriasis Day
- 2016/05/26Senegal Patients Association joins PIN!
- 2015/08/04Epidermia Greece: a new partner association of PIN
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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
Our ambition in a changing landscape of psoriasis treatments.
J Dermatolog Treat. 2020 Mar , 31, (2):105-107.
CARD14/CARMA2sh and TANK differentially regulate poly(I:C)-induced inflammatory reaction in keratinocytes.
J. Cell. Physiol.. 2020 Mar , 235, (3):1895-1902.
CARD14/CARMA2sh (CARMA2sh) is a scaffold protein whose mutations are associated with the onset of human genetic psoriasis and other inflammatory skin disorders. Here we show that the immunomodulatory adapter protein TRAF family member-associated NF-κB activator (TANK) forms a complex with CARMA2sh and MALT1 in a human keratinocytic cell line. We also show that CARMA2 and TANK are individually required to activate the nuclear factor κB (NF-κB) response following exposure to (...)see on pubmed
Prohibitin 1 interacts with signal transducer and activator of transcription 3 in T-helper 17 cells.
Immunol. Lett.. 2020 Mar , 219:8-14.
T-helper 17 (Th17) cells are involved in the occurrence and development of several inflammation-associated diseases. Interleukin (IL)-17, the main cytokine secreted by differentiated Th17 cells, mediates immunoreactions and plays important roles in immunological diseases, including psoriasis, rheumatic arthritis, and inflammatory bowel disease. The maturation and stabilization of the differentiated Th17 cell phenotype are associated with the expression of IL-17A, which is induced by the (...)see on pubmed
Off-label studies on apremilast in dermatology: a review.
J Dermatolog Treat. 2020 Mar , 31, (2):131-140.
Apremilast is a phosphodiesterase-4 inhibitor FDA approved for psoriatic arthritis and moderate to severe plaque psoriasis. In recent years, multiple studies have suggested other potential uses for apremilast in dermatology. A summary of these various studies will be a valuable aid to dermatologists considering apremilast for an alternative indication. The PubMed/MEDLINE and ClinicalTrials.gov databases were queried with the term 'apremilast,' with results manually screened to identify (...)see on pubmed
Atopic dermatitis induces anxiety- and depressive-like behaviors with concomitant neuronal adaptations in brain reward circuits in mice.
Prog. Neuropsychopharmacol. Biol. Psychiatry. 2020 Mar 02, 98:109818.
Clinically, it has been reported that atopic dermatitis (AD) has been linked with negative emotional problems such as depression and anxiety, thereby reducing the quality of life, but little is known about the molecular mechanism that underlies AD-associated emotional impairments. We sought to determine whether AD could induce anxiety- and depressive-like symptoms in mice and to identify pertinent signaling changes in brain reward circuitry. AD-like lesions were induced by the repeated (...)see on pubmed
Efficacy and safety of indigo naturalis ointment in Treating Atopic Dermatitis: A randomized clinical trial.
J Ethnopharmacol. 2020 Mar 25, 250:112477.
Indigo naturalis, a herbal medicine with a history of use dating back to ancient times, may be a good alternative topical treatment for atopic dermatitis (AD).see on pubmed