Skin vital signs essential

Health care providers collect temperature, respiration rate, pulse, blood pressure, and other vital signs at every patient visit. Dermatologists should also be collecting their own set of vital signs from skin.

“Skin vital signs are not just blunt measures such as body surface area or number of lesions,” said Mary-Margaret Chren, MD, professor and chair of dermatology at Vanderbilt University Medical Center. “The skin vital signs are patient reports of the intensity of their symptoms and, more importantly, the effect of their symptoms on their quality of life. Those patient reports are vital information for the dermatologist.”

Patient reports of their experience are not new, Dr. Chren noted. The patient experience is the subject of a growing body of literature, and both the FDA and the NIH require patient-reported outcomes for a growing range of clinical trials.

Applying patient reports to dermatology and using patients’ own experiences to guide and improve their care is an area that has long been championed by Dr. Chren and has helped earn her the Clarence S. Livingood Memorial Award and Lectureship for 2018.

Patient reports are not just helpful, she said — they are essential to delivering the best possible care for each patient. Algorithms can diagnose skin cancers as accurately as dermatologists, she noted. “An algorithm can recognize a skin cancer, but it cannot deal with the uncertainties at the patient level that define appropriate treatment and good patient care,” she said. “The algorithm cannot distinguish between the patient who is unconcerned with a high-risk melanoma in the context of other, seemingly more immediate medical concerns from the patient who is highly anxious about a low-risk basal cell carcinoma. That is what makes the dermatologist so essential and what makes patient reports such an essential part of delivering the best care to each of our patients.”

Studies back up this assertion. An oncology trial that compared usual care to usual care plus weekly patient reports on their own experience of disease and treatment found statistically and clinically important differences. Patients who submitted weekly reports to their treating oncologists — who in turn used those reports to evaluate and adjust treatment — had better quality of life, fewer emergency room visits, longer toleration of chemotherapy, and improved survival.

“When we incorporate the skin vital signs — patient reports of their own experience — into our practice, we can better document the value of our care, improve our care, and improve our patients’ outcomes,” she said.


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