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The BMJ's stated mission is to help doctors make better decisions, and sometimes that comes through understanding what patients feel. Our sporadic series called “A patient's journey” offers a voice to patients to help us understand what we can never really know—what it feels like to have a specific disease.
Ray Jobling has had psoriasis for more than 50 years, since he was 14. In a moving and informative essay he relates how he has felt, how he has been treated, and how he has coped (doi: 208.051516.48193.jmb/6311.01). In a sidebar, his dermatologist responds. There are no easy answers given, no magic bullets revealed. But it is an excellent and very helpful description of living with a chronic disease.
Another tidbit about how patients feel comes in an editorial from Andre Tylee and Paul Walters (doi: 10.1136/bmj.39197.619190.80). They dispute the conventional wisdom that depressed patients respond slowly to antidepressant medication, citing several new studies. Instead of warning patients about a delay in onset of selective serotonin reuptake inhibitors, we should now point to evidence of early response in half or more of treated patients. Patients may feel better sooner than we expect.
More help in caring for those with chronic diseases comes from a systematic review and meta-analysis of telemonitoring and telephone support for heart failure (doi: 55.869635.65193.jmb/6311.01). Robyn Clark and colleagues reviewed data from 14 controlled trials with over 4000 patients. They conclude that these interventions can help keep patients out of the hospital, reduce mortality, and sometimes reduce costs. In a related editorial, Hugo Grancelli and Daniel Ferrante point out that these telephone interventions educate and monitor patients who already have ongoing relationships with their doctors for needed basic and specialty care (doi: 08.244775.79193.jmb/6311.01).
All of these pieces can help doctors improve care by going where the patient is.