In this issue, dermatological diseases, treatment options and cases
Do you treat your acne?
For common skin problems such as acne, you may consult a specialist or rely on alternative medicine.
Illness = doctor
A little trouble = on your own
In many cases, the hurdles to seeing a doctor or specialist are ambiguous.
This is not to say that all alternative medicine is at fault, but how should we respond to patients who choose such options?
Here is a case study that will help you learn about these issues.
Case
A 15-year-old woman
She came back to the clinic with her father because she had severe prurigo nodularis cystica.
She has been treated for this condition with topical treatments (retinoids and benzoyl peroxide) and oral antibiotics, but her acne has not improved.
She and her father are concerned about the scarring around her chin.
During a previous visit to the clinic, the doctor and her father had discussed the use of oral isotretinoin as a treatment.However, the father is not convinced about something.
This is because of the risk of side effects from the treatment with oral isotretinoin.
Because of that too, her father is looking into alternative therapies and is thinking of starting her on a ketone diet therapy combined with Megi extract and topical tea tree oil instead of the medication.
There are four possible courses of action for the doctor to take from this, but consider what is appropriate and where the problem lies.
(a) Explain to her and her father that there is no proof of efficacy for the alternative therapy they are trying, and because of concerns about scarring, they need to seriously consider treatment with oral isotretinoin without regard to the potential risks.
(b) Discharge the patient from the practice because her father is not amenable.
(c) You could refer the patient to the university hospital, but this would be troublesome because it would inconvenience your colleagues at the university.
(d) Suggest the use of a combination of alternative and conventional therapies.
Consider the response to the case
In the present case, it is obvious that the best option is to respond to a).
The physician needs to avoid paternalism by discussing the risks of the alternative therapies the father is considering, clearly explaining the risks and benefits of the current treatment, and encouraging him to continue taking the medication.
And doctors need to dismiss alternative medical research and sham medical treatments so as not to undermine patient trust.
In option d), if her acne has not scarred even after several months of treatment with alternative medicine, it is considered a reasonable approach.
Severe prurigo nodularis cysticerca can leave significant scarring, which can seriously affect her psychological aspect.Therefore, neither the continuation of conventional treatments nor the suggested alternative treatments may be effective in the current situation.
Therefore, the doctor should direct her and her father away from alternative therapies in favor of treatment with oral isotretinoin.
It is true that there is a risk of side effects with oral isotretinoin, but there is also a risk of potential harm with other options.
Option b) has the potential to cause harm by increasing the likelihood that she will not get the medical care she needs.
Option c) is inappropriate because it is similar to option b) and may not address the patient's needs.
This option simply shifts the responsibility to someone else.
If the patient is receptive, it is reasonable to offer the patient the opportunity to have a second opinion.
Belanger M, Grant-Kels JM. Nature, nurture, or nuisance: The ethical issues that surround alternative medicine. Int J Womens Dermatol. 2017;3(4):237- 238. published 2017 Jun 15. doi:10.1016/j.ijwd.2017.05.004
Conclusion
In this case, the concern about the side effects of medication led to the suggestion of alternative medicine, and the doctor's response to the suggestion was discussed.
This is a rather common situation, isn't it?
In my experience, when I told the doctor that I wanted an alternative treatment, the doctor responded with b).
I wonder if he thinks that his self-esteem has been damaged.
Of course, there are many times when alternative medicine should be the choice, and many times when it is not.
Of course, there are times when alternative medicine should be chosen and many times when it should not.
No matter what the case may be.
