You’re the fifth dermatologist the patient has seen. What will it take to get this patient well?
Have you ever been the fifth dermatologist a patient has seen for a particular problem? If you have, what sense do you have of the likelihood of treatment success with that patient?
VICIOUS CYCLE
Too many patients return for follow-up frustrated by the lack of improvement in their disease. Thus begins a vicious circle. Patients who do not get better with the medicine prescribed by the first dermatologist tend to become frustrated by treatment and by the dermatologist. They will then seek care from a second dermatologist. Already doubtful they can be helped, they will have little faith in this dermatologist and even less in the one after that.
If they fill their prescriptions at all, they will use the medications prescribed by these later doctors only minimally at best. This leads to more and more frustration, mistrust, poor adherence to treatment, and poor outcomes — both for these patients and their doctors.
THE PROBLEM: POOR COMPLIANCE
This patient is now coming to see you. Can you break this cycle? You can if you understand how it started. Treatment failure of this type is a marker of poor compliance, dreadfully poor compliance. Poor compliance explains why the very first treatment wasn’t effective and why subsequent attempts at treatment were even worse. When patients with common but treatment-resistant problems have seen several dermatologists previously, it is very likely that they are very non-compliant patients.
If this problem is not recognized, treatment is doomed to fail. It won’t matter that you make an accurate diagnosis of the skin condition. It won’t matter that you prescribe the exact right treatment. You can bet that at least one and probably all of the previous dermatologists already did both those things.
BREAKING THE CYCLE
To achieve success in these patients when other dermatologists did not, you must address compliance. These patients are easily frustrated and will not use a medication unless they see it working quickly. Usually the window of opportunity is just a few days. If you can get the patient to use the prescribed treatment really well for the first few days and they see that it works, the cycle of frustration and poor adherence can be broken.
But how can you get the patient to use the treatment well for the first few days? It’s actually quite easy. First, you have to make this patient trust you. Then, you have to make the patient think the treatment is just for a few days. Making changes for a lifetime is tough. Doing something for 8 weeks is tough. Doing almost anything for 3 days is a lot easier.
A PERSONAL APPROACH: THE KEY TO SUCCESS
Start by giving the patient the impression you really care about him or her. (All too often we truly care about patients but don’t communicate it to them.) Sit close to them. Palpate their lesions as you examine them. Ask them about how frustrating the previous treatments have been. Then tell them you’re very concerned about their condition and that you know that treatment will be difficult. Give them the prescription, ask them to use it twice a day and tell them this: “I want to see you back in 3 days to make sure you are getting better.”
Telling them you want to see them back in 3 days to make sure they are getting better isn’t exactly a lie, but it isn’t the whole truth, either. You need to see them back in 3 days to make them use the medication.
If you have any doubts about how this works, just imagine your dentist sitting next to you, putting his or her hand on your shoulder and saying, “I’m really worried about your gums. I want you to floss at least twice a day. I’ll see you back in 3 days.” How much more flossing would you do?
THE BOTTOM LINE
The success or failure of dermatologic treatment generally depends on three things: compliance, compliance and compliance. We could probably stop all new drug development and for the next 10 years wring more efficacy out of the agents we already have just by learning new ways to improve patients’ compliance behavior.
Just develop your skills at managing patients’ compliance, and you will be a more effective dermatologist. n
Steven R. Feldman, M.D., Ph.D.
Chief Medical Editor
You’re the fifth dermatologist the patient has seen. What will it take to get this patient well?
Have you ever been the fifth dermatologist a patient has seen for a particular problem? If you have, what sense do you have of the likelihood of treatment success with that patient?
VICIOUS CYCLE
Too many patients return for follow-up frustrated by the lack of improvement in their disease. Thus begins a vicious circle. Patients who do not get better with the medicine prescribed by the first dermatologist tend to become frustrated by treatment and by the dermatologist. They will then seek care from a second dermatologist. Already doubtful they can be helped, they will have little faith in this dermatologist and even less in the one after that.
If they fill their prescriptions at all, they will use the medications prescribed by these later doctors only minimally at best. This leads to more and more frustration, mistrust, poor adherence to treatment, and poor outcomes — both for these patients and their doctors.
THE PROBLEM: POOR COMPLIANCE
This patient is now coming to see you. Can you break this cycle? You can if you understand how it started. Treatment failure of this type is a marker of poor compliance, dreadfully poor compliance. Poor compliance explains why the very first treatment wasn’t effective and why subsequent attempts at treatment were even worse. When patients with common but treatment-resistant problems have seen several dermatologists previously, it is very likely that they are very non-compliant patients.
If this problem is not recognized, treatment is doomed to fail. It won’t matter that you make an accurate diagnosis of the skin condition. It won’t matter that you prescribe the exact right treatment. You can bet that at least one and probably all of the previous dermatologists already did both those things.
BREAKING THE CYCLE
To achieve success in these patients when other dermatologists did not, you must address compliance. These patients are easily frustrated and will not use a medication unless they see it working quickly. Usually the window of opportunity is just a few days. If you can get the patient to use the prescribed treatment really well for the first few days and they see that it works, the cycle of frustration and poor adherence can be broken.
But how can you get the patient to use the treatment well for the first few days? It’s actually quite easy. First, you have to make this patient trust you. Then, you have to make the patient think the treatment is just for a few days. Making changes for a lifetime is tough. Doing something for 8 weeks is tough. Doing almost anything for 3 days is a lot easier.
A PERSONAL APPROACH: THE KEY TO SUCCESS
Start by giving the patient the impression you really care about him or her. (All too often we truly care about patients but don’t communicate it to them.) Sit close to them. Palpate their lesions as you examine them. Ask them about how frustrating the previous treatments have been. Then tell them you’re very concerned about their condition and that you know that treatment will be difficult. Give them the prescription, ask them to use it twice a day and tell them this: “I want to see you back in 3 days to make sure you are getting better.”
Telling them you want to see them back in 3 days to make sure they are getting better isn’t exactly a lie, but it isn’t the whole truth, either. You need to see them back in 3 days to make them use the medication.
If you have any doubts about how this works, just imagine your dentist sitting next to you, putting his or her hand on your shoulder and saying, “I’m really worried about your gums. I want you to floss at least twice a day. I’ll see you back in 3 days.” How much more flossing would you do?
THE BOTTOM LINE
The success or failure of dermatologic treatment generally depends on three things: compliance, compliance and compliance. We could probably stop all new drug development and for the next 10 years wring more efficacy out of the agents we already have just by learning new ways to improve patients’ compliance behavior.
Just develop your skills at managing patients’ compliance, and you will be a more effective dermatologist. n
Steven R. Feldman, M.D., Ph.D.
Chief Medical Editor
You’re the fifth dermatologist the patient has seen. What will it take to get this patient well?
Have you ever been the fifth dermatologist a patient has seen for a particular problem? If you have, what sense do you have of the likelihood of treatment success with that patient?
VICIOUS CYCLE
Too many patients return for follow-up frustrated by the lack of improvement in their disease. Thus begins a vicious circle. Patients who do not get better with the medicine prescribed by the first dermatologist tend to become frustrated by treatment and by the dermatologist. They will then seek care from a second dermatologist. Already doubtful they can be helped, they will have little faith in this dermatologist and even less in the one after that.
If they fill their prescriptions at all, they will use the medications prescribed by these later doctors only minimally at best. This leads to more and more frustration, mistrust, poor adherence to treatment, and poor outcomes — both for these patients and their doctors.
THE PROBLEM: POOR COMPLIANCE
This patient is now coming to see you. Can you break this cycle? You can if you understand how it started. Treatment failure of this type is a marker of poor compliance, dreadfully poor compliance. Poor compliance explains why the very first treatment wasn’t effective and why subsequent attempts at treatment were even worse. When patients with common but treatment-resistant problems have seen several dermatologists previously, it is very likely that they are very non-compliant patients.
If this problem is not recognized, treatment is doomed to fail. It won’t matter that you make an accurate diagnosis of the skin condition. It won’t matter that you prescribe the exact right treatment. You can bet that at least one and probably all of the previous dermatologists already did both those things.
BREAKING THE CYCLE
To achieve success in these patients when other dermatologists did not, you must address compliance. These patients are easily frustrated and will not use a medication unless they see it working quickly. Usually the window of opportunity is just a few days. If you can get the patient to use the prescribed treatment really well for the first few days and they see that it works, the cycle of frustration and poor adherence can be broken.
But how can you get the patient to use the treatment well for the first few days? It’s actually quite easy. First, you have to make this patient trust you. Then, you have to make the patient think the treatment is just for a few days. Making changes for a lifetime is tough. Doing something for 8 weeks is tough. Doing almost anything for 3 days is a lot easier.
A PERSONAL APPROACH: THE KEY TO SUCCESS
Start by giving the patient the impression you really care about him or her. (All too often we truly care about patients but don’t communicate it to them.) Sit close to them. Palpate their lesions as you examine them. Ask them about how frustrating the previous treatments have been. Then tell them you’re very concerned about their condition and that you know that treatment will be difficult. Give them the prescription, ask them to use it twice a day and tell them this: “I want to see you back in 3 days to make sure you are getting better.”
Telling them you want to see them back in 3 days to make sure they are getting better isn’t exactly a lie, but it isn’t the whole truth, either. You need to see them back in 3 days to make them use the medication.
If you have any doubts about how this works, just imagine your dentist sitting next to you, putting his or her hand on your shoulder and saying, “I’m really worried about your gums. I want you to floss at least twice a day. I’ll see you back in 3 days.” How much more flossing would you do?
THE BOTTOM LINE
The success or failure of dermatologic treatment generally depends on three things: compliance, compliance and compliance. We could probably stop all new drug development and for the next 10 years wring more efficacy out of the agents we already have just by learning new ways to improve patients’ compliance behavior.
Just develop your skills at managing patients’ compliance, and you will be a more effective dermatologist. n
Steven R. Feldman, M.D., Ph.D.
Chief Medical Editor
