Val Dock talks to DrB

The Combined Approach in Primary Care: An interview with Valerie Dock MBBS

Valerie Dock MBBS qualified in Medicine at The Royal Free Hospital, London UK in 1973. With further training in Obstetrics and Gynaecology, and Family Planning, she has worked in London as a family physician in primary care for over thirty five years. She has a special interest in dermatology, and is enthusiastic about The Combined Approach and the difference it can make for people with atopic eczema.

DrB: Val, when did you start using The Combined Approach to atopic eczema, and why?

VD: I first heard about The Combined Approach 10 years ago, on a Dermatology Course for general practitioners at the St John's Institute of Dermatology, here in London. It made absolute sense to me, both as a past eczema sufferer, and as a general practitioner. Then I came and sat in on some clinics with you at Chelsea and Westminster Hospital, to see how it was done - and I was hooked!

DrB: Do you use the programme as we use it, or have you adapted it?

VD: I have made the programme more compatible with primary care - with prior knowledge of the patient and having available the general practice records, the appointments can be shorter than you have in the hospital setting*. Even so, I use up to 30 minutes for the initial appointment, so I have to fit this in after my regular clinic time. The extra time input is invaluable - the good results I have had have made this clear. But the follow-up appointments are incorporated into regular clinic time, initially as double appointments - that is 20 minutes.

DrB: How easy or difficult did you find it, to learn as a technique? What previous training had you had, to help you?

VD: It was easy, as it makes so much sense. I had no special training, apart from sitting in with you.

DrB: Do you use the programme for both adults and children?

VD: I have used the principles when advising parents of younger children. All the patients I have used The Combined Approach for have been between 14 and 63 years old, with the majority in their 30's.

DrB: What has been your experience overall?

VD: It's perhaps important to explain that for many family doctors eczema is a "heart sink" condition, because they can feel impotent in making a difference. In using The Combined Approach however the patient is really empowered to take charge of their eczema and stop it controlling their lives. It's worth investing a little extra time teaching the patient a new and effective management option: the patient is often impressed that the general practitioner is showing interest in their skin - sometimes for the first time!

DrB: Can you summarize your results so far?

VD: Of the 19 patients to whom I have offered the programme, I have documented results for the 13 who have attended at least 3 times: all report either a good or excellent response to the treatment programme.

DrB: How do you see The Combined Approach fitting in to primary care?

VD: It fits in well: what would be ideal would be to have it offered by a trained practice nurse, who would be able to give it more time. However any enthusiastic general practitioner, who would like to see an effective management programme for atopic eczema, would be well rewarded.

DrB: Do you use the self-help version of the programme,  as in "The Eczema Solution" by Sue Armstrong Brown?

VD: Yes, I recommend Sue's book. It is enthusiastically received - but people are also increasingly asking for advice about reliable websites.

DrB: Would this website help?

VD: Yes, this is an excellent resource, for the patient and for the practitioner, not only in conjunction with using The Combined Approach in primary care, but also for on-going support.

DrB: Thank you Val.

The Combined Approach to atopic eczema is easily offered in primary care, by both medical and nursing practitioners.