Tip 1: Psychodermatology: The Importance Of Empathy
Much of the business in my practice is generated through referral, and often the patients who are referred to me have already seen a number of different doctors — sometimes as many as 10 — across a variety of specialties. In addition, these patients have frequently undergone numerous unnecessary, and oft repeated, tests and biopsies.
Increasingly, I hear from these patients a variety of complaints, such as:
“The doctor didn’t even look at me.”
“The doctor didn’t examine me.”
“The doctor told me I was crazy.”
And other comments in a similar vein.
I fully understand that, in the current economic climate, we are all pressured to produce, and seldom have the luxury to spend much time with each patient. On the other hand, the patient whose needs, whether physical or emotional, are not met inevitably becomes a tremendous financial burden on our over-taxed medical system, continuing the pattern of fruitless doctor shopping.
Patients who express a psychiatric problem in dermatologic terms, such as those with a cutaneous delusion or dermatitis artefacta, are essentially a part of every practice, and are, I think, particularly difficult for dermatologists. These patients are generally demanding and manipulative and ready with anger that may, in turn, make the doctor angry, which therefore creates an impasse. In order to avoid such an impasse, the doctor should not be afraid to take control, courteously limiting time and the number of tests and biopsies.
It helps to introduce yourself with a handshake and a welcoming smile and to sit down so you are on the same level as the patient. You can explain that time is limited and ask he or she to try just to answer your questions. Try to be aware of your emotional response and recognize that, if there is anger, it is the patient’s problem, not yours as the physician.
Acknowledge the patient’s anger and empathize with it. Empathize with the patient’s distress, and make sure the patient understands that you know what he or she is going through, and that what is described is exactly what he or she is experiencing — that something is indeed going on in the skin. You can explain the symptoms in terms of chemical changes in the skin, or neuropeptide release, possibly triggered by stress, or you can acknowledge that you don’t exactly know what is causing the symptom. Then, you can introduce the appropriate psychotropic drug, explaining that, like many other medications, this has several different actions, one of which is to relieve the type of symptom the patient is experiencing.
It is both surprising and rewarding to note how effective an empathic attitude is in forging a positive and lasting doctor-patient relationship.
Caroline S. Koblenzer, MD
Philadelphia, PA
Tip 2: Minimizing Discomfort from Topical Treatments
When using topical calcineurin inhibitors such as tacrolimus or pimecrolimus, patients may sometimes experience burning after the first few applications, which may greatly hinder compliance. The burning sensation can be reduced by taking a 325 mg aspirin 1 hour prior to applying the cream/ointment. Patients can also place the cream/ointment in the fridge 15 minutes before applying it to the skin, which makes it more soothing.
Dr. Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada
Tip 3: Bleach Baths For Atopic Dermatitis
For patients with infected atopic dermatitis, in addition to antibiotics, consider prescribing daily bleach baths. Instruct the patient to add one-quarter cup of laundry bleach to a tub of lukewarm water and sit and soak for fifteen minutes. The weak bleach solution will effectively reduce the amount of Staphylococci on the skin.
Brian T. Maurer, MS, PA-C
Enfield, CT
Tip 4: Talking To Patients With Warts
There are a number of things I tell my patients who have warts:
• The numerous treatments that are used for warts are testimony to the fact that we don’t have any definite “cure” for them.
• More often than not, warts tend to “cure” themselves over time.
• The hero of successful wart treatment is usually the last person to treat the wart or the last person to recommend a treatment before the wart goes away.
• The “wart hero” may have been a wart charmer, a hypnotist or a person who recommended a folk medicine, such as the application of garlic or aloe vera, or even… a dermatologist.
Herb Goodheart, MD
Poughkeepsie, NY
Tip 5: The Patient As A Therapeutic Ally
Getting patients to become your allies in therapy is important. As dermatologists, we know that liquid nitrogen treatment hurts, and I have found a simple trick to perhaps help ease the pain. While spraying the lesion and seeing the patient not enjoying the discomfort, I would often use the magic line: “You can feel it’s working.” All of a sudden, this pain becomes therapeutic and patients seem to be more willing to accept it as meaningful. The idiom “no pain, no gain” is helpful. Similarly, explaining to patients that inflammation associated with the treatment of skin cancers – eg, imiquimod or 5-fluorouracil treatment – “means that the treatment is working” often goes a long way in increasing compliance with therapy.
Anatoli Freiman, MD, FRCPC
Toronto, Ontario, Canada
Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of six books in dermatology and is widely published in the dermatology and humanities literature.
He is also co-editor of Dermanities (dermanities.com), an online journal devoted to the humanities as they relate to dermatology.
Tip 1: Psychodermatology: The Importance Of Empathy
Much of the business in my practice is generated through referral, and often the patients who are referred to me have already seen a number of different doctors — sometimes as many as 10 — across a variety of specialties. In addition, these patients have frequently undergone numerous unnecessary, and oft repeated, tests and biopsies.
Increasingly, I hear from these patients a variety of complaints, such as:
“The doctor didn’t even look at me.”
“The doctor didn’t examine me.”
“The doctor told me I was crazy.”
And other comments in a similar vein.
I fully understand that, in the current economic climate, we are all pressured to produce, and seldom have the luxury to spend much time with each patient. On the other hand, the patient whose needs, whether physical or emotional, are not met inevitably becomes a tremendous financial burden on our over-taxed medical system, continuing the pattern of fruitless doctor shopping.
Patients who express a psychiatric problem in dermatologic terms, such as those with a cutaneous delusion or dermatitis artefacta, are essentially a part of every practice, and are, I think, particularly difficult for dermatologists. These patients are generally demanding and manipulative and ready with anger that may, in turn, make the doctor angry, which therefore creates an impasse. In order to avoid such an impasse, the doctor should not be afraid to take control, courteously limiting time and the number of tests and biopsies.
It helps to introduce yourself with a handshake and a welcoming smile and to sit down so you are on the same level as the patient. You can explain that time is limited and ask he or she to try just to answer your questions. Try to be aware of your emotional response and recognize that, if there is anger, it is the patient’s problem, not yours as the physician.
Acknowledge the patient’s anger and empathize with it. Empathize with the patient’s distress, and make sure the patient understands that you know what he or she is going through, and that what is described is exactly what he or she is experiencing — that something is indeed going on in the skin. You can explain the symptoms in terms of chemical changes in the skin, or neuropeptide release, possibly triggered by stress, or you can acknowledge that you don’t exactly know what is causing the symptom. Then, you can introduce the appropriate psychotropic drug, explaining that, like many other medications, this has several different actions, one of which is to relieve the type of symptom the patient is experiencing.
It is both surprising and rewarding to note how effective an empathic attitude is in forging a positive and lasting doctor-patient relationship.
Caroline S. Koblenzer, MD
Philadelphia, PA
Tip 2: Minimizing Discomfort from Topical Treatments
When using topical calcineurin inhibitors such as tacrolimus or pimecrolimus, patients may sometimes experience burning after the first few applications, which may greatly hinder compliance. The burning sensation can be reduced by taking a 325 mg aspirin 1 hour prior to applying the cream/ointment. Patients can also place the cream/ointment in the fridge 15 minutes before applying it to the skin, which makes it more soothing.
Dr. Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada
Tip 3: Bleach Baths For Atopic Dermatitis
For patients with infected atopic dermatitis, in addition to antibiotics, consider prescribing daily bleach baths. Instruct the patient to add one-quarter cup of laundry bleach to a tub of lukewarm water and sit and soak for fifteen minutes. The weak bleach solution will effectively reduce the amount of Staphylococci on the skin.
Brian T. Maurer, MS, PA-C
Enfield, CT
Tip 4: Talking To Patients With Warts
There are a number of things I tell my patients who have warts:
• The numerous treatments that are used for warts are testimony to the fact that we don’t have any definite “cure” for them.
• More often than not, warts tend to “cure” themselves over time.
• The hero of successful wart treatment is usually the last person to treat the wart or the last person to recommend a treatment before the wart goes away.
• The “wart hero” may have been a wart charmer, a hypnotist or a person who recommended a folk medicine, such as the application of garlic or aloe vera, or even… a dermatologist.
Herb Goodheart, MD
Poughkeepsie, NY
Tip 5: The Patient As A Therapeutic Ally
Getting patients to become your allies in therapy is important. As dermatologists, we know that liquid nitrogen treatment hurts, and I have found a simple trick to perhaps help ease the pain. While spraying the lesion and seeing the patient not enjoying the discomfort, I would often use the magic line: “You can feel it’s working.” All of a sudden, this pain becomes therapeutic and patients seem to be more willing to accept it as meaningful. The idiom “no pain, no gain” is helpful. Similarly, explaining to patients that inflammation associated with the treatment of skin cancers – eg, imiquimod or 5-fluorouracil treatment – “means that the treatment is working” often goes a long way in increasing compliance with therapy.
Anatoli Freiman, MD, FRCPC
Toronto, Ontario, Canada
Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of six books in dermatology and is widely published in the dermatology and humanities literature.
He is also co-editor of Dermanities (dermanities.com), an online journal devoted to the humanities as they relate to dermatology.
Tip 1: Psychodermatology: The Importance Of Empathy
Much of the business in my practice is generated through referral, and often the patients who are referred to me have already seen a number of different doctors — sometimes as many as 10 — across a variety of specialties. In addition, these patients have frequently undergone numerous unnecessary, and oft repeated, tests and biopsies.
Increasingly, I hear from these patients a variety of complaints, such as:
“The doctor didn’t even look at me.”
“The doctor didn’t examine me.”
“The doctor told me I was crazy.”
And other comments in a similar vein.
I fully understand that, in the current economic climate, we are all pressured to produce, and seldom have the luxury to spend much time with each patient. On the other hand, the patient whose needs, whether physical or emotional, are not met inevitably becomes a tremendous financial burden on our over-taxed medical system, continuing the pattern of fruitless doctor shopping.
Patients who express a psychiatric problem in dermatologic terms, such as those with a cutaneous delusion or dermatitis artefacta, are essentially a part of every practice, and are, I think, particularly difficult for dermatologists. These patients are generally demanding and manipulative and ready with anger that may, in turn, make the doctor angry, which therefore creates an impasse. In order to avoid such an impasse, the doctor should not be afraid to take control, courteously limiting time and the number of tests and biopsies.
It helps to introduce yourself with a handshake and a welcoming smile and to sit down so you are on the same level as the patient. You can explain that time is limited and ask he or she to try just to answer your questions. Try to be aware of your emotional response and recognize that, if there is anger, it is the patient’s problem, not yours as the physician.
Acknowledge the patient’s anger and empathize with it. Empathize with the patient’s distress, and make sure the patient understands that you know what he or she is going through, and that what is described is exactly what he or she is experiencing — that something is indeed going on in the skin. You can explain the symptoms in terms of chemical changes in the skin, or neuropeptide release, possibly triggered by stress, or you can acknowledge that you don’t exactly know what is causing the symptom. Then, you can introduce the appropriate psychotropic drug, explaining that, like many other medications, this has several different actions, one of which is to relieve the type of symptom the patient is experiencing.
It is both surprising and rewarding to note how effective an empathic attitude is in forging a positive and lasting doctor-patient relationship.
Caroline S. Koblenzer, MD
Philadelphia, PA
Tip 2: Minimizing Discomfort from Topical Treatments
When using topical calcineurin inhibitors such as tacrolimus or pimecrolimus, patients may sometimes experience burning after the first few applications, which may greatly hinder compliance. The burning sensation can be reduced by taking a 325 mg aspirin 1 hour prior to applying the cream/ointment. Patients can also place the cream/ointment in the fridge 15 minutes before applying it to the skin, which makes it more soothing.
Dr. Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada
Tip 3: Bleach Baths For Atopic Dermatitis
For patients with infected atopic dermatitis, in addition to antibiotics, consider prescribing daily bleach baths. Instruct the patient to add one-quarter cup of laundry bleach to a tub of lukewarm water and sit and soak for fifteen minutes. The weak bleach solution will effectively reduce the amount of Staphylococci on the skin.
Brian T. Maurer, MS, PA-C
Enfield, CT
Tip 4: Talking To Patients With Warts
There are a number of things I tell my patients who have warts:
• The numerous treatments that are used for warts are testimony to the fact that we don’t have any definite “cure” for them.
• More often than not, warts tend to “cure” themselves over time.
• The hero of successful wart treatment is usually the last person to treat the wart or the last person to recommend a treatment before the wart goes away.
• The “wart hero” may have been a wart charmer, a hypnotist or a person who recommended a folk medicine, such as the application of garlic or aloe vera, or even… a dermatologist.
Herb Goodheart, MD
Poughkeepsie, NY
Tip 5: The Patient As A Therapeutic Ally
Getting patients to become your allies in therapy is important. As dermatologists, we know that liquid nitrogen treatment hurts, and I have found a simple trick to perhaps help ease the pain. While spraying the lesion and seeing the patient not enjoying the discomfort, I would often use the magic line: “You can feel it’s working.” All of a sudden, this pain becomes therapeutic and patients seem to be more willing to accept it as meaningful. The idiom “no pain, no gain” is helpful. Similarly, explaining to patients that inflammation associated with the treatment of skin cancers – eg, imiquimod or 5-fluorouracil treatment – “means that the treatment is working” often goes a long way in increasing compliance with therapy.
Anatoli Freiman, MD, FRCPC
Toronto, Ontario, Canada
Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of six books in dermatology and is widely published in the dermatology and humanities literature.
He is also co-editor of Dermanities (dermanities.com), an online journal devoted to the humanities as they relate to dermatology.
Tip 2: Minimizing Discomfort from Topical Treatments
For patients with infected atopic dermatitis, in addition to antibiotics, consider prescribing daily bleach baths. Instruct the patient to add one-quarter cup of laundry bleach to a tub of lukewarm water and sit and soak for fifteen minutes. The weak bleach solution will effectively reduce the amount of Staphylococci on the skin.
Tip 4: Talking To Patients With Warts
