Both dermatologists and patients have expectations of what might result from an office visit. Dermatologists hope to meet the patient’s expectations and heal or address their concerns. Patients also have an expectation, and meeting those expectations yields patient satisfaction and a good patient/physician interaction.
Both dermatologists and patients have expectations of what might result from an office visit. Dermatologists hope to meet the patient’s expectations and heal or address their concerns regarding diseases of the skin, hair or nails. Patients also have an expectation, and meeting those expectations yields patient satisfaction and a good patient/physician interaction. The challenge is identifying those patient expectations.
I am increasingly aware of the effects of the media on dermatology patient expectations. Patients frequently come to their office visits with pages torn from magazines and Internet downloads. My nurse dutifully clips these to the medical chart to allow me to examine the materials before entering the exam room. know that the “clip” sign means that this will be a challenging visit.
The patient may bring a picture of a pair of lips they find attractive and would like filler injections to reproduce on their face. The lips belong to a perfume advertisement model that is one-third the age of the patient.
Sometimes the patient will bring a magazine ad for a moisturizing cream with dramatic before and after results yielding an amazingly more youthful appearance. Examining the images yields a clear Photoshop improvement, as the shadows do not emanate from a single point light source.
Finally, the patient may bring an Internet piece describing a death that occurred from botulinum toxin injections. Examination of this material indicates the information was excerpted from an old newspaper article describing a singular event where a physician illegally injected animal botulinium toxin in an inappropriately high dose into humans.
Next: Responding to patient expectations
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How should the dermatologist respond to these “clip” signs? The patient clearly has expectations that must be met and it will be hard to meet these challenges. Old lips cannot be turned into young lips; it may be difficult to convince the patient that Photoshop - not the moisturizer - produced the wonderful “after” images; and one misuse of botulinum toxin does not mean it is universally dangerous. Some patients will accept this analysis of the “clip” information while others will challenge the physician. How do we in dermatology manage this reality/expectation mismatch?
There are several possibilities: 1. You could not allow patients to bring materials for clipping to the chart. 2. You could give the patient an MMPI before they are seen in the office. 3. You could tear up the papers and thank them for bringing them while quickly moving on. 4. You could try to explain the issues to the patient.
I think most of us would select No. 4 and try to properly educate the patient carefully reconciling expectations and reality.
However, reconciling expectation and reality could be facilitated by an increase in the accuracy of media materials. Young ladies with saline-filled lips immediately injected before the photoshoot should be identified as such in a disclaimer at the bottom of the ad. Photoshopped “after” images should be labeled as digitally altered. Out-of-context reporting should be avoided by referencing the originally published material. Bringing expectations and reality into line in the dermatologic arena is partly the job of the physician, but also the job of the media and governmental agencies that supervise truth in advertising.
In the meantime, learn to recognize the “clip” sign!