Asking the right questions at the right time can help cultivate stronger relationships with skin disease patients and make sure they are getting the best possible treatment for their eczema, psoriasis, or other cutaneous conditions, according to experts speaking at the Science of Skin panel discussion in New York City hosted by AbbVie.
Here are seven ways to scratch beneath the surface and discover how your eczema and psoriasis patients are doing.
- Ask open-ended questions
A simple ‘how are you?’ goes a long way, says Elyse Love, MD, a New York City-based dermatologist. “You would be surprised to know how much information certain patients reveal when you ask how they are doing,
2. Be explicit about timing
Instead of asking a patient ‘how has your psoriasis been?’ ask ‘how has your psoriasis been since I last saw you?’, suggests Chesahna Kindred, MD, MBA, a dermatologist at Kindred Hair & Skin Center in Baltimore, MD. This is important as it encourages the patient to focus on their answer. “Asking about how they have been since last time will provide more detailed information on the interval change, and they won’t compare their current state to a really severe flare five years ago,” she says. “Once a patient is better, a lot of times they really divulge how bad things were.”
- Tie questions to the disease state
Ask disease-specific questions, Dr. Kindred says. “For psoriasis patients, I ask, ‘when you wake up, are your joints stiff in the morning instead of ‘do you have arthritis?’ For atopic dermatitis (AD), I can ask if itch interrupts sleep, which will help a lot.”
Dr. Love agrees. Many people with eczema are up all night scratching. “Asking about sleep directly can help uncover how the itch is affecting the patient’s quality of life.”
- Take a beat
Give your patients time to explain what’s going on with their skin. “This is our chance to know the patient’s story,” Dr. Kindred says. “Our job is to provide relief, but if we don’t know what the urgent need is, we can miss it.”
The depth of these conversations will evolve over time as the doctor-patient relationship grows.
“As a patient and I get to know each other, I can ask specific questions that pertain to their life, such as ‘Are you able to play the piano again?’” Dr. Love said. “This helps me to finetune their treatment to get them back to doing the things that they love.”
Dr. Kindred will often ask about emotional well-being after the initial visit.
- Listen to the patient’s treatment goals
Don’t overtreat patients, Dr. Kindred says. “We might not feel that a patient is better until every flake of psoriasis gone, but they just might want to wear black again.”
- Consider using PROMs
Patient-reported outcome measures, or PROMs, can be very helpful for dermatologists who work in busy clinics. “These allow patients to fill out a survey before they are seen by a doctor, and the doctor can review it and use this information to guide the conversation about treatment goals,” Dr. Love says. These questionnaires also give patients a chance to reflect on how the skin disease is impacting their lives, she says. Some PROMS for eczema include the Itch-Controlled Days (ItchCD) scale, the Dermatological Life Quality Index (DLQI), the Itch Numerical Rating Scale (NRS), the 5-Pruritus Life Quality (5PLQ), and the EuroQol Visual Analogue Scale. Psoriasis PROMS include Psoriasis Symptoms and Signs Diary (PSSD), DLQI, and Work Limitations Questionnaire (WLQ).
- Put a number on it
Dr. Love asks patients to rate their itch before and after treatment using a 1-10 numerical scale to see how well they are doing on their regimen. This information can be used to determine if any treatment changes are needed.
PHOTO CAPTION: Melissa Joan Hart, center, is joined by health care professionals, patients and advocates at AbbVie’s Science of Skin event to help empower and inspire self-advocacy in patients diagnosed with chronic skin diseases, Thursday, Aug. 8, 2024 in New York.
PHOTO CREDIT: Jason DeCrow/AP Content Services for AbbVie
