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eifective approach to management. Secondly, we recommend a return to the treatment of each patient as a whole person, with appropriate attention to the relevance of constructive support and encouragement, if the more potent treatments that are now available are to be made as effective as possible. It is ironic that otherwise the alienation that seems so characteristic of being a patient in the latter part of the 20th century leads to neglect of the good treatments available, and the search for solace with alternative therapies offered by herbalists and other non-scientific traditional healers from other cultures.
4.5 Follow-up
Early Following our protocol, the treatment instructions are completed by the end of the second consultation. The early follow-up at the third appointment, together with the fourth visit, monitors progress in treatment at all the three levels detailed above. Each time the patient attends they should bring with them their handbook and record of progress. Registration of scratching should show a frequency of less than 20 per day by the fourth visit. Review At each of these visits it is helpful first to focus on a review of scratching behaviour noting scratching frequency over the last seven days, the situations when it is most troublesome, and from the patient's point of view how much of the scratching is still coming from itch. Then the focus turns to the eczema itself, noting the severity again from the patient's point of view on the scale 0-10 as before, where the rash is to be found, and finally the proportion of the eczema that is old and long-standing, as opposed to newly arrived (p. 53). If these six points are recorded at each visit, the record becomes standardised and can be more easily reviewed subsequently (p. 64, Fig 4.15).
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Treatment review Progress in treatment can then be discussed by taking each level of treatment in turn. At each level there is a need to review the rationale, and ensure that the best possible results are being achieved. It is helpful to check