Topic 5: Turn the Conversation Into a Plan

A shared decision is not complete until the plan is specific enough to carry out and revisit. Document the goal, chosen option, key tradeoff, monitoring responsibilities, and timing of reassessment. If the patient defers treatment, document the reason and create a safety-net plan rather than labeling the patient ‘noncompliant.’

Plan element	Example documentation
Patient priority	Reduce painful work-limiting flares and drainage
Decision and rationale	Selected option after discussing expected benefit, safety, administration, access, and alternatives
Success measure	Fewer flares and less missed work; no new tunnel or involved region
Responsibilities	Who completes authorization, screening, monitoring, wound care, and specialist follow-up
Reassessment	When response and tolerability will be reviewed; what triggers earlier contact

US prescribing context: Treatment selection and counseling must reflect current FDA-approved labeling, contraindications, warnings, monitoring requirements, and applicable US guidance. The non-dermatologist should work within scope and coordinate advanced medical or procedural care when appropriate.

North American HS guidance and a recent US expert management algorithm support tailoring medical and procedural care to disease severity, response, safety, and individual clinical circumstances. They provide the clinical boundaries within which preference-sensitive decisions should occur.⁴ ⁵