Idalis Bailey, RN, MBA, Licensed Medical Aesthetician, Certified Laser Technician
Dr. Mariel Cabrera, MD, Master’s in Public Health and Epidemiology, Master’s in Aesthetic Medicine
Dr. Giselle García Moro, MD, Master’s in Clinical Aesthetic and Orthomolecular Medicine
Glenda Alicea, Licensed Aesthetician (USA), Master’s in Cosmetics and Aesthetic Medicine, PhD in Social Work
Ariana Morales, Degree in Nutrition, Diploma in Nutrition and Physical Activity, Master’s in Applied Nutrition, Doctoral Candidate in Education
Introduction
The purpose of this document is to explore how a multidisciplinary approach can be effectively implemented to address the multiple dimensions of a patient’s condition. Handling cases with multifaceted characteristics, as described, requires collaboration between specialists in hormonal health, psychology, aesthetic medicine, clinical aesthetics, and nutrition. Through the integration of their knowledge and approaches, it is possible to design a treatment plan that addresses not only the physical symptoms but also the patient’s emotional and nutritional needs.
Importance of the Multidisciplinary Approach
The multidisciplinary approach in aesthetic medicine is not new [1]. It is established that such an approach impacts the patient experience and outcomes by addressing their multifaceted needs. Moreover, as the healthcare landscape undergoes significant transformations driven by demographic shifts, evolving patient expectations, and rapid technological advancements, a multidisciplinary approach in aesthetic medicine becomes even more essential.
The complexity of this patient’s case highlights the importance of a multidisciplinary approach to her treatment. Each medical and therapeutic discipline brings a unique and necessary perspective to address the various aspects of the patient’s condition. Collaboration among endocrinologists, dermatologists, psychologists, nutritionists, and aestheticians allows for comprehensive treatment that goes beyond symptom relief. This coordinated approach facilitates the identification and treatment of underlying causes, improves patient adherence to treatment, and optimizes overall outcomes. The integration of these disciplines ensures that the treatment is thorough, addressing not only the physical manifestations of the condition but also the emotional and psychological impacts, ensuring the patient receives care centered on all her needs.
Focus Group
A focus group of experts from various disciplines was convened to develop this protocol. Focus groups are highly effective for gathering diverse types of information. When topics or concepts are explored in a social context through focused group discussions, complex, nuanced, and in-depth ideas often emerge [2].
The group included five specialists: a hormonal specialist, psychologist, aesthetic doctor, aesthetician, and nutritionist. The session lasted four hours, focusing on discussing and analyzing the case from a multidisciplinary perspective. During this forum, a complex clinical case was presented, allowing for detailed discussion and analysis by the specialists. The following recommendations were collected based on these deliberations. This collaborative approach ensures that the developed protocol is based on a wide range of knowledge and experiences, ensuring comprehensive and high-quality care for the patient. Participants discussed and analyzed the case from their respective perspectives to identify the most appropriate interventions and develop a comprehensive treatment protocol.
The specific objectives of the focus group were:
- Understanding the Interaction of Factors: Analyzing how physical, emotional, and nutritional symptoms interact and affect the patient’s overall condition.
- Identifying Specific Interventions: Determining the best treatment strategies from each discipline to address the various aspects of the patient’s condition.
- Developing a Coordinated Treatment Plan: Creating a protocol that integrates various interventions coherently, ensuring all areas of the patient’s health are effectively addressed.
- Providing a Guide for Similar Cases: Offering a reference framework that can be applied to other similar cases in clinical practice.
Case Description
The 35-year-old patient presents with type IV skin and thick black hair, experiencing excessive hair growth on her face, intimate areas, legs, and underarms. This condition is accompanied by folliculitis, irritation, and facial acne, as well as hyperpigmentation in intimate areas and underarms. Emotionally and psychologically, she faces low self-esteem and an eating disorder, along with menstrual irregularities, indicating a possible hormonal imbalance. These issues are interrelated, complicating her treatment and highlighting the need for an integrated approach.
Focus Group Summary
Medical Treatment:
- Considerations for Type IV Skin: The patient requires specific laser settings to minimize the risk of hyperpigmentation and other adverse effects.
- Managing Excess Hair and Skin Conditions: The treatment should not only target hair removal but also address issues like folliculitis and irritation.
Emotional and Psychological Impact:
- Self-Esteem and Psychological Well-being: It is crucial to address the patient’s low self-esteem, which is linked to her physical condition and emotional identity.
- Eating Disorder: The intervention must consider how emotional and psychological issues influence eating habits and vice versa.
Hormonal Interventions:
- Testosterone Evaluation and Management: Assessing how testosterone is metabolized and its impact on hair growth is fundamental.
- Blood Sugar Regulation: Dietary and lifestyle strategies should stabilize blood sugar levels and manage conditions like PCOS.
Nutritional Interventions:
- Comprehensive Nutritional Assessment: A detailed evaluation is necessary to identify deficiencies and guide dietary recommendations.
- Anti-inflammatory Diet: It is recommended to avoid inflammatory foods and promote a nutrient-rich diet beneficial for hormonal and skin health.
Multidisciplinary Approach:
- Collaboration and Coordination: Treatment effectiveness depends on integrating approaches from different disciplines.
- Personalized Treatment Plans: Each plan must be tailored to the patient’s specific needs, considering her physical and emotional conditions.
Laser Safety and Efficacy:
- Customized Laser Settings: Adjusting the laser settings to minimize risks is crucial for successful treatment.
- Pre-treatment Evaluation and Precautions: A detailed consultation and preventive measures are necessary to ensure treatment safety.
Multidisciplinary Protocol
This protocol aims to establish a comprehensive framework for managing patients with complex conditions that affect multiple aspects of their health. Specifically, this protocol focuses on treating a patient with hormonal imbalances, dermatological issues, low self-esteem, and eating disorders. The goal is to provide an integrated and coordinated approach that ensures the appropriate care of their physical, emotional, and nutritional needs, thus improving their overall quality of life and well-being. This protocol emphasizes the importance of collaboration between various medical and therapeutic specialties, ensuring that each aspect of the treatment is addressed cohesively and effectively.
This protocol should be applied based on the specific type of patient. Based on the initial assessment, it will be determined whether specific specialty evaluations are required. Not all evaluations are absolutely necessary, but the possibility of requiring such assessments should be considered.
Figure 1 presents a schematic of this protocol.
I. Initial Patient Evaluation
Complete Medical History: Details of the medical history, family background, and system review.
II. Specific Specialty Evaluations (see Figure 2)
- Dermatological Evaluation: Skin examinations and tests related to skin conditions.
- Endocrine Evaluation: Hormonal tests and analyses (testosterone, insulin, etc.).
- Psychological Evaluation: Psychological tests and clinical interviews to assess emotional and mental health.
Nutritional Evaluation: Diet analysis, tests for nutritional deficiencies, and evaluation of eating disorders.
III. Comprehensive Treatment Plan (see Figure 3)
- Medical Treatment: The medical treatment will include dermatological and endocrinological approaches.
- Endocrine:
- Hormonal Interventions: Medication to balance hormone levels (e.g., metformin for insulin resistance, treatments for PCOS).
- Laboratory Monitoring: Regular monitoring of hormone levels and other key markers.
- Dermatology:
- Pre- and Post-Treatment Care: Skincare routines, creams, and treatments to minimize irritation and hyperpigmentation.
- Pre- and Post-Treatment Care: Skincare routines, creams, and treatments to minimize irritation and hyperpigmentation.
- Endocrine:
- Psychological Treatment:
- Psychological Therapies: Cognitive-behavioral therapies, acceptance and commitment therapies, and other psychological interventions.
- Emotional Support: Support groups, counseling sessions, and resources for self-esteem and stress management.
- Nutritional Treatment:
- Personalized Diet Plan: Anti-inflammatory diet, specific recommendations to manage blood sugar levels, and key nutrients.
- Nutritional Education: Guidance on food choices, healthy eating habits, and the relationship between nutrition and hormonal health.
- Laser Treatment:
- Personalized Laser Settings: Adjusting laser settings to minimize risks is crucial for successful treatment.
- Pre-Treatment Evaluation and Precautions: Conducting a detailed consultation and taking preventive measures to ensure the safety of the treatment.
IV. Monitoring and Evaluation
- Development of Progress Indicators: Creating clear metrics to evaluate treatment progress in terms of physical, emotional, and nutritional health.
- Care Continuity Planning: Strategies to ensure the patient receives continuous and coordinated follow-up care across all disciplines.
- Patient Feedback: Incorporating the patient’s perspective and satisfaction in the evaluation of treatment and making adjustments based on their needs and feedback.
V. Education and Summary
- Progress and Outcomes Summary: Final report on the patient’s condition upon completion of the protocolized treatment.
- Educational Guides and Resources for the Patient: Suggestions for maintaining the patient’s well-being and possible long-term follow-up needs.
Figure 1. Diagram of the multidisciplinary protocol
INITIAL EVALUATION: Complete medical history
Figure 2. Diagram of the specific evaluation
Figure 3. Diagram of the treatment plan
NOTE: It is important to notify that in the First Focus Group we had the collaboration of the following experts:
- Idalis Bailey, Nurse & Laser Hair Removal Specialist
- Ariana Morales, Nutritionist & Specialist in Gerontological Nutrition
- Glenda Alicea, PhD (c) in Education & Master in Aesthetic Medicine
- Maraya Brown, Yale and Functional Medicine trained Women’s Health Expert & Nurse Practitioner
- Dr. Mariel Cabrera, Master in Aesthetic Medicine, Nutrition, and Anti-aging
- Dr. Giselle Garcia Moro, Aesthetic Medicine and Orthomolecular Specialist
References
- Zeini, H. The Interdisciplinary Approach to Teaching Aesthetic Medicine. 2024. Available from: https://hanizeinischolarship.com/the-interdisciplinary-approach-to-teaching-aesthetic-medicine/
Cyr, Jennifer, ‘Focus Groups’, in Jennifer Cyr, and Sara Wallace Goodman (eds), Doing Good Qualitative Research (New York, 2024; online edn, Oxford Academic, 30 Apr. 2024), https://doi.org/10.1093/oso/9780197633137.003.0019, accessed 17 Sept. 2024.
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IDALIS BAILEY
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Nurse, MBA – Marketing, NYS Licensed Medical Aesthetician & Certified Laser with more of 18 Years Experience
