Twelve weeks, not twelve years

Saoirse Nolan had been on the same first-line treatment for three years, because nobody had booked the appointment at which it would be reconsidered.

Flare plans are written down with thresholds, so treatment starts on day one of a flare rather than on day nine when it has become unbearable.

A year on

Under-treatment driven by fear of a treatment is more common in this clinic than over-treatment, and the fear is usually acquired from well-meaning advice.

Without a review date, first-line becomes permanent. That’s not a clinical decision, it’s an administrative accident.

Dr. Ilse Marchand, dermatology

What teledermatology triaged

Photograph-based triage moved most urgent lesion referrals to an answer within a fortnight, and moved the queue for benign findings out of the way entirely.

Every prescription on this pathway now carries a review date. “That’s it,” she says. “That’s the whole change.”