Time and atopic eczema

author/source: DrB


In 2013 at the meeting of the European Society for Dermatology and Psychiatry in Roskilde, Denmark, dermatologist Makoto Hashiro reported from Japan a finding from his research that confirms a problem in Dermatology here in the UK too. His colleagues reported that involving a psychological element in treating skin complaints was problematic because it can involve too much time.

Working myself in our dermatology clinic over the years, patients remarked on how as a psychiatrist I was noticeably different from my dermatology colleagues: I spent more time with them. If the dermatologist spent five minutes, the psychiatrist spends thirty minutes. If the dermatologist spends fifteen minutes, the psychiatrist spends sixty.

Specialists work in different ways, otherwise they would not be specialists, but there are reasons for thinking that spending more time dealing with some skin complaints can be associated with better outcomes. Generally, research shows that a good rapport between doctor and patient is positively associated with good treatment outcome, and achieving rapport takes time. Speedy consultations tend towards being unsatisfactory, for both doctor and patient.

Bill Gould, and Jennifer emphasize elsewhere here the importance of doctors and patients communicating well.

But in particular with atopic eczema and The Combined Approach, we have found much truth in the old saying “spending time saves time”.

Our treatment programme eliminates chronic eczema in a few weeks, and then focuses on treating acute eczema flare-ups effectively. We use a Quality of Life questionnaire to measure outcome, and the questions it asks are mostly to do with time. The more time the illness takes up, the greater the negative effect on Quality of Life, for the patient of course, not the doctor! Using The Combined Approach we find very significant positive Quality of Life improvement persisting  at one year follow-up.

And this would seem to save time in the long run for the doctor too, as the patient dealing successfully with their condition has no need to return to the doctor for further advice. Perhaps this is the answer for Makoto Hashiro to his colleagues in Japan:

“If you spend time now, you save time later!”