Treating the patient as well as the disease

Treating the patient as well as the disease
Dr Antoni Chan, Consultant Rheumatologist and Physician, Royal Berkshire Hospital talks about how to achieve optimal outcomes by involving patients in the discussion of the Six Domains and how they can influence the management of their condition.
Psoriatic Arthritis (PsA) is a very diverse disease, with each patient presenting with different combinations of the Six Domains. Today, we are lucky enough to have a wide range of treatment and management options available to address the different domains effectively, which therefore allows for a bespoke management plan and also places a greater emphasis on patient choice.
In order to do this successfully, as clinicians it is really important for us to develop a strong dialogue with our patients built on trust and effective engagement. The misalignment of the patient and doctor goals in the consultation can lead to suboptimal outcomes and management of the condition.
In my opinion the key to success is for us to put ourselves in the patient’s shoes, to ensure that we fully understand their perspective and align ourselves to their personal long-term treatment and lifestyle goals. In our clinic, one way that we do this is by sending two very simple questions to our patients before their consultation;
  1. What do you want to achieve from your treatment?
  2. What really matters to you today?
We can then use the Six Domains as a real-time assessment to make effective treatment choices, which can be routinely adjusted to reflect the patients’ needs. From day to day, I find that a patient’s combination of the active domains can be very different from that of the last consultation and as such, certain treatments can be added or swapped to address the symptoms they are currently experiencing. In the same light, there is often one primary domain which active in patients at all times, and this can be identified as the long-term focus in the management of the condition.
This patient-centred approach really does help us develop an overarching, personalised, goal for treatment, while also addressing the patients’ immediate needs based on the symptoms experienced at that time, and those which are causing greatest impact to them.

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