Case Scenario: Psoriasis Consultation

Summary:

This case scenario involves a consultation for a patient with psoriasis. The focus is on history-taking, diagnosis, management, and patient communication, particularly emphasizing empathetic discussion and clear, patient-friendly explanations.

Key Points:

History Taking:

• General history:

  • Ensure history-taking is structured and relevant to the condition.

  • Avoid overly medical terminology when summarizing for the patient.

• Aggravating and precipitating factors:

  • Specifically ask if stress worsens the condition.

  • Inquire about any contact history: "Is there anyone at work or home with similar symptoms?" (not just family).

  • Ask about previous treatments: “Have you tried anything for it?”

• Associated symptoms and system review:

  • Joint pain, fever, eye problems → Good coverage.

  • Additional check: Any other lesions elsewhere on the body?

• Psychosocial aspects:

  • Smoking and alcohol history were covered.

  • Need to explicitly ask about stress and how it affects daily life.

Diagnostic Approach:

• The diagnosis of psoriasis was correctly made.

• Avoid using phrases like “presented with” when explaining the condition to the patient.

• Instead, confirm patient understanding: “Let’s go through what we’ve discussed, just to be sure you understand everything.”

Management Plan:

• General treatment:

  • Explain that the dermatologist will likely prescribe steroids to help reduce symptoms quickly.

  • Mention emollients and vitamin D preparations as part of the standard treatment regimen.

  • Explain steroid use: Apply emollients first, then steroids after 30 minutes (same approach as eczema).

• Lifestyle advice:

  • Address stress management.

  • Discuss weight control as obesity can worsen psoriasis flares.

• Follow-up and safety netting:

  • Advise the patient to monitor for complications: joint pain, vision issues, or worsening symptoms.

  • Provide patient leaflets and support resources.

Communication Skills:

• Summarization should be appropriate to the stage of consultation:

  • After history → Summarize history only.

  • After management discussion → Summarize management only.

• Avoid clinical jargon; use patient-friendly language.

• Instead of just giving solutions, empathize first:

  • Example: “I can understand that must be very stressful. One way to manage this could be wearing full sleeves to cover the lesions.”

Ethical Considerations:

• Ensure shared decision-making with the patient.

• Use clear, non-technical language to explain treatment.

• Be mindful of psychosocial factors, including stress and self-image concerns.

Additional Resources:

• NICE guidelines on psoriasis management.

• GMC Good Medical Practice guidance on effective patient communication​.

• Patient support groups for psychosocial support.