A Psoriatic Patient-Based Survey on the Understanding of the Use of Vaccines While on Biologics During the COVID-19 Pandemic

Background Psoriatic patients who are actively receiving biologic treatment have protocols in place to achieve optimal immunity. Inactivated vaccines are safe to use during biological treatment, without interruption. Conversely, live vaccines are used with caution and likely interruption of treatment. Given the novel coronavirus (SARS-CoV-2), nation-wide administration of vaccinations is underway. Objective This survey gathered information on the level of education psoriatic patients have concerning vaccinations. Methods An electronic survey was sent to 661 patients suffering from psoriasis. Patients originated from a single solo-practitioner community-based dermatology practice. Results The average percentage of patients who understand the difference between live and inactivated vaccines between the control and study group was 36.6%. The average response to not knowing the difference between the vaccines was 36.6% and 26.6% were “unsure.” When asked if it was possible to receive inactivated vaccines while on a biologic, the mass response amidst the control and study group was “unsure” (66.9%). Conclusion This questionnaire demonstrates that there is a need for supplementary education about vaccines for psoriatic patients on a biologic. Physicians will need to counsel their patients on the use of potential vaccines for SARS-Cov2 while on biologics.

“The Noblest Roman of them all?” Professional versus Popular Views of America’s Country Doctors

This essay studies the images, perceptions, and values of the professional medical journals, as well as popular sources such as magazine and films, to show that the country doctor was a contested figure in the late nineteenth and early twentieth centuries. The country doctor’s image embodied competing ideals of a racialized professional and masculine identity that included both place as well as visions of science. Medical professionals pressed an image in their journals and professional advice books that mapped a celebration of science and its predictive value onto urban places that were enshrined in hospitals and laboratory facilities. The public, while embracing this image, also embraced a second one shown in popular media that glorified the self-sacrificing rural solo practitioner. This practitioner’s wisdom came from long contact with patients, he was dedicated to seeing patients in their homes, and his identity was based in the larger needs of the entire community.

Experiencing Positive Health, as a Family, While Living With a Rare Complex Disease: Bringing Participatory Medicine Through Collaborative Decision Making Into the Real World

Physician–patient collaboration was recognized as a critical core of participatory medicine more than a century ago. However, the subsequent focus on scientific research to enable cures and increased dominance of physicians in health care subordinated patients to a passive role. This paternalistic model weakened in the past 50 years—as women, minorities, and the disabled achieved greater rights, and as incurable chronic diseases and unrelieved pain disorders became more prevalent—promoting a more equitable role for physicians and patients. By 2000, a shared decision-making model became the pinnacle for clinical decisions, despite a dearth of data on health outcomes, or the model’s reliance on single patient or solo practitioner studies, or evidence that no single model could fit all clinical situations. We report about a young woman with intractable epilepsy due to a congenital brain malformation whose family and medical specialists used a collaborative decision-making approach. This model positioned the health professionals as supporters of the proactive family, and enabled them all to explore and co-create knowledge beyond the clinical realm. Together, they involved other members of the community in the decisions, while harnessing diverse relationships to allow all family members to achieve positive levels of health, despite the resistance of the seizures to medical treatment and the incurable nature of the underlying disease.

Experiencing Positive Health, as a Family, While Living With a Rare Complex Disease: Bringing Participatory Medicine Through Collaborative Decision Making Into the Real World (Preprint)

UNSTRUCTURED Physician–patient collaboration was recognized as a critical core of participatory medicine more than a century ago. However, the subsequent focus on scientific research to enable cures and increased dominance of physicians in health care subordinated patients to a passive role. This paternalistic model weakened in the past 50 years—as women, minorities, and the disabled achieved greater rights, and as incurable chronic diseases and unrelieved pain disorders became more prevalent—promoting a more equitable role for physicians and patients. By 2000, a <i>shared decision-making model</i> became the pinnacle for clinical decisions, despite a dearth of data on health outcomes, or the model’s reliance on single patient or solo practitioner studies, or evidence that no single model could fit all clinical situations. We report about a young woman with intractable epilepsy due to a congenital brain malformation whose family and medical specialists used a <i>collaborative decision-making approach</i>. This model positioned the health professionals as supporters of the proactive family, and enabled them all to explore and co-create knowledge beyond the clinical realm. Together, they involved other members of the community in the decisions, while harnessing diverse relationships to allow all family members to achieve positive levels of health, despite the resistance of the seizures to medical treatment and the incurable nature of the underlying disease.

DBT in Private Practice

Offering DBT as a solo practitioner presents a variety of challenges that require clinicians to balance altruistic values of a helping professional with the financial realities of business ownership. This chapter discusses decisions to make and pitfalls to avoid in setting up a DBT practice; dialectical solutions uniting clinical service and financial need are proposed throughout. Decisions about practice set-up should be guided by Linehan’s notion of functions of treatment and modes of delivery. Comprehensive DBT is best delivered to fidelity in a structure where clinicians as separate business entities can share a single location where all modes can be delivered in the same space. Practical guidance is given for handling payment-related matters in the context of the therapy relationship, and non-payment of fees is conceptualized as client treatment-interfering behaviour, while failure to target these difficulties is conceptualized as therapist treatment-interfering behaviour. Finally, it shows how to provide DBT with fidelity and also run a profitable business.

What Is Known About the Psychodermatology Clinic Model of Care? A Systematic Scoping Review

Background: Psychodermatology focuses on the interaction between skin and mental health. Existing research discusses the recognition and treatment of these disorders. However, little is known about the operational structure of subspecialised psychodermatology clinics. Objective: To identify literature on the structure and logistics of delivering a psychodermatology service. Methods: A systematic search of MEDLINE, PsycINFO, Embase, and Google Scholar was performed. Articles were included if they discussed the concept and organisation of a psychodermatology practice. Results: We identified 693 studies; after screening titles and abstracts, 35 full-text articles were assessed, and 17 were included in the scoping review. Most articles discussed aspects of clinic organisation in general; others discussed management of a clinic in the context of specific diseases or made recommendations on incorporating psychotherapeutic techniques in a solo practitioner setting. A weekly multidisciplinary clinic or resident teaching clinic with joint dermatologist-psychiatrist consultation is the most commonly reported model. Specifically, a stepped level of care approach is often used, where patients in increasing level of distress are stratified to the appropriate team of trained professionals. A corresponding curriculum to supplement practitioners’ knowledge is recommended. Conclusions: Various clinic models have been described to provide specialised psychodermatology care in specific settings. Research is needed to assess the impact of these multidisciplinary models of care on patient outcomes and health care costs.