Off next week to talk about The Combined Approach, at a meeting in Birmingham UK for dermatology nurses, who are brushing up on aspects of eczema care. There are sessions on moisturizers, the psychology of skin disease, and patient support, patient education and patient choice.
This last week's post bag to atopicskindisease.com included an email from a new member lamenting about the experience of 10 minutes with the NHS Dermatologist every six months, and describing the planning that goes into how to extract the maximum benefit from the short time available.
Infinite demands, finite resources. This is why I am going to Birmingham next week. I think I am the only psychiatrist who is also a member (honorary) of the British Association of Dermatologists. Psychodermatology, the field that links mental health and dermatology, is a speciality of dermatology more than psychology or psychiatry. It is understood and practised by more dermatologists than psychologists or psychiatrists. Arguably there is a world-wide shortage of psychiatrists, but dermatologists are much thinner on the ground: so how can the important benefits of psychodermatology be made more available?
One important difference between the psychiatrist and the dermatologist is in the allocation of time with the patient: the psychiatrist might have an hour or more with a new patient, while the dermatologist has perhaps a third or a quarter of this. Psychological assessment and treatment take time, as well as an appreciation of the relevance of empathetic support, holistic care and patient education. Where can psychodermatology find the necessary resources?
My own hunch is that the fully-fledged dermatology nurse specialist or practitioner is the answer. If all dermatology services provided nurse-led psychodermatology clinics, there is no doubt in my mind that the standard of skin care would dramatically improve for all dermatology patients. Nurse-led, but multidisciplinary - with input from dermatologists, psychologists, psychiatrists and social workers too. I suggest the future of psychodermatological care is not with dermatologists, or psychiatrists, but with nurses. I am delighted so many have now joined as members of this site: I look forward to meeting them, and learning from them, next week.
What do you think?
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