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Psychological Impact of Plaque Psoriasis


Nicholas Brownstone, MD, and James Q. Del Rosso, DO, comment on the psychological impact of plaque psoriasis on a patient’s quality of life.

James Q. Del Rosso, DO: Let’s move to a little bit of a different area because it could involve any of these patients. How do you assess where they are psychologically? How do you assess whether they’re thinking about suicide or whether they’re depressed or whether they need some psychological help? Because we’re talking about medications and all that; that’s a big part of what we do. But how do you assess the psychology of where they’re at?

Nicholas Brownstone, MD: I wanted to mention that because the first thing that jumped out at me was how plaque psoriasis can greatly impact this quality of life. There have been many studies that show that psoriasis affects patients as much as other major medical disorders. So, it’s very important to remember to be a doctor first and a dermatologist second. We all went to medical school, and we know that patients want help, and they want to be heard. So, the first thing I’d say is, very simply and quickly, “How is it affecting you?” They’ll tell you, and you validate that by saying, “Hey, it seems like it’s really affecting you. I’m going to get you better.” And those couple of words or sentences are going to make the biggest difference in that patient’s life.

James Q. Del Rosso, DO: What questions would you ask? Because what I picture is that your patients come in, they know Dr Sammons. They say, “Hi, how are you doing?” They’re not necessarily spilling their guts about how miserable they feel about their disease. All very social, patients are happy to see you. It becomes like a social visit, you give them their medicine and they’re gone, but nobody ever really finds out what’s actually going on inside their head. So are there certain questions that you ask that are simple, that clinicians can use to get a sense of their psychological status?

Nicholas Brownstone, MD: Just very simply ask, “How is this affecting you? Tell me about how this is affecting you.” That opens up the conversation. A lot of other people probably don‘t bring that up to them. Anybody can write a script for a biologic or a topical medication. But what makes a doctor someone special is addressing these psychological concerns, which, a lot of times, are overlooked in a busy clinic and something that we should all strive to do better as we grow in our practices.

James Q. Del Rosso, DO: Do you ask them about how they interact with other people? How it affects people at home? Or do you ask them in general, “How is this affecting you? How does this bother you on a day-to-day basis?”

Nicholas Brownstone, MD: I practice what I call tactical empathy, which is taking that empathy up to the highest level. Like you’re an Academy Award–winning actor, and the patient comes in with a couple spots of psoriasis. I usually say, “Oh, this must be horrible.” And they’ll either say, “Yes, doctor, it is. Thank you so much. No one’s ever talked about like that with me before. I’m glad you finally recognized that,” or “No, it’s not that bad." And I’ll say, “OK, good. Well, I’m glad to hear that, but we‘re going to get you better.” And I think that’s a great way to approach things. But just recognizing it, labeling it, and validating their concerns is very important.

James Q. Del Rosso, DO: That’s great. Any other comments on that?

Brad Glick, DO, FAOCD: I would add that you have to ask about their occupation or what they like to do recreationally. Then some of those great questions that Nick just asked can be added into that setting, how to fix their interaction with their friends, with their spouse. They’re a golfer. They’re trying to golf, and it’s not fun following through in your golf swing when you’ve got really bad plaques on your elbows and your knees. So, I think in that regard, how’s it affecting you, you can segue into a whole series of additional questions that really captures how it impacts the patient’s quality of life.

Transcript edited for clarity

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