Fig 4.2 Protocol ASSESSMENT then One week registration
INSTRUCTION then Two weeks treatment
REVIEW then Two weeks treatment
circumstances. What follows is only an illustration of the approach in practice (Fig 4.2). The themes of the process involved apply at each visit, with particular issues requiring review on more than one occasion, if change in attitude and successful self-management are to be accomplished. As major themes, Assessment, Treatment and Follow-up can be considered in sequence, though in practice these stages overlap and inter-relate considerably. The current protocols for visits at the Daniel Turner Department of Dermatology, Chelsea & Westminster Hospital are detailed in Appendix 1, though they are adapted frequently to suit particular patients, and varying circumstances.
Full and shorter versions FOLLOW-UP ADVICE then Follow-up period
What follows is a complete account of all the techniques currently used. The protocols are only guidelines. It may well be that the 'minimal effective dose' will prove to be less than the full programme described. An approach where the essentials are explained and emphasised as logical can leave the individual to decide on how to proceed. Spending more rather than less time with our patients has however allowed us to gain a greater understanding of the otherwise 'secret world' of the atopic patient with skin disease. The impression gained is clear the more time spent initially means less time spent later.
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4.2 Assessment Following referral the patient is seen at the Chelsea & Westminster Hospital for dermatological diagnosis before being referred on for The Combined Approach programme. Assessment for the programme begins with the second visit and continues through to the third visit, when overt treatment is introduced. In primary helath care, dermatological diagnosis and assessment for this programme can be simultaneous.
Explicit and implicit functions Assessment is an obvious process to both therapist and it clarifies the dermatological diagnosis, elucipatient dates the history of illness, the current condition of the patient and the current treatment being used. A complete
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