As dermatologists we all have our individual styles of practice and favorite areas of dermatology on which we prefer to focus. But we all share one thing in common: We have a strong desire to improve our skills. Getting input from colleagues can help us achieve this goal. This column will highlight a wide range of pearls from practicing dermatologists — everything from a better way to perform a clinical procedure to a more effective method for communicating with patients to advice for improving an office function.
Tip 1: Breaking Bad News
I’ve had breast cancer (12 years out). The surgeon was going to give me a call about the results of the pathology test and I knew it would be back by Friday. I didn’t get a call until Monday afternoon and it was the worst weekend of my life. I knew that she would have called me with good news, but guessed that she thought that I could have one more good weekend by waiting until Monday to call. I imagined bad news worse than I got. I now tell people that their spot might be a melanoma. I also tell them it is easier to give good news by telephone rather than bad. I give them a choice of a telephone call from me as soon as I get the report or waiting for the scheduled office visit to review in person. If they decide upon a telephone call, I ask them what they want me to do if they do not answer. I also let them know that I think it is very difficult to leave a message with a spouse that the patient has a diagnosis of melanoma. I tell people that I can just leave a call- back number or leave a detailed message. Most people really want to know as soon as possible and give a personal cell phone number so a spouse won’t get the bad news first. They usually want me to leave a detailed message. Most people are relieved with a telephone call as soon as possible. This plan might be something to consider if you are not breaking bad news this way. Becky Bushong, MD Carmel, IN
Tip 2: The Importance of Catch Phrases
I feel that it is a useful addition to one’s medical practice to have catch phrases for patient encounters. These “lines” can show that you are easygoing and provide for the occasional chuckle. Here are a few that I have picked up over the years from colleagues and some I’ve come up with myself: • On completing the patient encounter: “Well, you’re good for another 10, 000 miles.” • When discussing age spots like seborrheic keratoses: “These are weeds in the garden of life.” • On discharging a patient or returning them to their primary care provider: “Well, you’ve graduated!” • For patients who followed your directions and got better as a result: “Today my friend, you get a gold star.” Benjamin Barankin, MD, FRCPC Toronto, Canada
Tip 3: Managing Cysts
Incision and drainage of infected cysts can be risky to the clinician. Sudden expression of the cyst contents either when being infiltrated with anesthesia, when being incised or when pressure is applied to remove the wall and its contents, can occasionally result in an unwanted spray of material — blood, pus and more. Having a sandwich-type plastic bag on hand to place over the surgical area allows you to clearly be able to see the area to be incised and drained, but also contain potential scatter of contaminated fluids. This is another inexpensive piece of “equipment” in the surgical suite. Sandra Mamis, RPA-C Hudson Valley Dermatology Newburgh, NY
Tip 4: Putting Out Fires
If a patient has frequently recurrent dyshidrotic eczema, I will often explain that they can use a fire-hose treatment like clobetasol cream three to four times per day to put out the fire, and then once the fire is out, to prevent or minimize the number and severity of recurrences by applying topical tacrolimus or pimecrolimus at night time. Benjamin Barankin, MD, FRCPC Toronto, Canada
Tip 5: What Feet Have to do with Treating Hands with Botox
When treating patients’ hands with Botox, the amount of Botox required per hand is proportional to hand size, which is proportional to foot size. So you can tell how much they need over the phone, simply ask patients what size shoes they wear. Very roughly, for a male patient, a • size 8 shoe means each hand needs at least 80 units, • size 10 shoe means each hand needs at least 100 units, • size 12 shoe means each hand needs at least 120 units. So, it is true what they say about guys with big feet... they need more Botox for their hands. Kevin C. Smith, MD, FRCPC Canada Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of five 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.
As dermatologists we all have our individual styles of practice and favorite areas of dermatology on which we prefer to focus. But we all share one thing in common: We have a strong desire to improve our skills. Getting input from colleagues can help us achieve this goal. This column will highlight a wide range of pearls from practicing dermatologists — everything from a better way to perform a clinical procedure to a more effective method for communicating with patients to advice for improving an office function.
Tip 1: Breaking Bad News
I’ve had breast cancer (12 years out). The surgeon was going to give me a call about the results of the pathology test and I knew it would be back by Friday. I didn’t get a call until Monday afternoon and it was the worst weekend of my life. I knew that she would have called me with good news, but guessed that she thought that I could have one more good weekend by waiting until Monday to call. I imagined bad news worse than I got. I now tell people that their spot might be a melanoma. I also tell them it is easier to give good news by telephone rather than bad. I give them a choice of a telephone call from me as soon as I get the report or waiting for the scheduled office visit to review in person. If they decide upon a telephone call, I ask them what they want me to do if they do not answer. I also let them know that I think it is very difficult to leave a message with a spouse that the patient has a diagnosis of melanoma. I tell people that I can just leave a call- back number or leave a detailed message. Most people really want to know as soon as possible and give a personal cell phone number so a spouse won’t get the bad news first. They usually want me to leave a detailed message. Most people are relieved with a telephone call as soon as possible. This plan might be something to consider if you are not breaking bad news this way. Becky Bushong, MD Carmel, IN
Tip 2: The Importance of Catch Phrases
I feel that it is a useful addition to one’s medical practice to have catch phrases for patient encounters. These “lines” can show that you are easygoing and provide for the occasional chuckle. Here are a few that I have picked up over the years from colleagues and some I’ve come up with myself: • On completing the patient encounter: “Well, you’re good for another 10, 000 miles.” • When discussing age spots like seborrheic keratoses: “These are weeds in the garden of life.” • On discharging a patient or returning them to their primary care provider: “Well, you’ve graduated!” • For patients who followed your directions and got better as a result: “Today my friend, you get a gold star.” Benjamin Barankin, MD, FRCPC Toronto, Canada
Tip 3: Managing Cysts
Incision and drainage of infected cysts can be risky to the clinician. Sudden expression of the cyst contents either when being infiltrated with anesthesia, when being incised or when pressure is applied to remove the wall and its contents, can occasionally result in an unwanted spray of material — blood, pus and more. Having a sandwich-type plastic bag on hand to place over the surgical area allows you to clearly be able to see the area to be incised and drained, but also contain potential scatter of contaminated fluids. This is another inexpensive piece of “equipment” in the surgical suite. Sandra Mamis, RPA-C Hudson Valley Dermatology Newburgh, NY
Tip 4: Putting Out Fires
If a patient has frequently recurrent dyshidrotic eczema, I will often explain that they can use a fire-hose treatment like clobetasol cream three to four times per day to put out the fire, and then once the fire is out, to prevent or minimize the number and severity of recurrences by applying topical tacrolimus or pimecrolimus at night time. Benjamin Barankin, MD, FRCPC Toronto, Canada
Tip 5: What Feet Have to do with Treating Hands with Botox
When treating patients’ hands with Botox, the amount of Botox required per hand is proportional to hand size, which is proportional to foot size. So you can tell how much they need over the phone, simply ask patients what size shoes they wear. Very roughly, for a male patient, a • size 8 shoe means each hand needs at least 80 units, • size 10 shoe means each hand needs at least 100 units, • size 12 shoe means each hand needs at least 120 units. So, it is true what they say about guys with big feet... they need more Botox for their hands. Kevin C. Smith, MD, FRCPC Canada Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of five 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.
As dermatologists we all have our individual styles of practice and favorite areas of dermatology on which we prefer to focus. But we all share one thing in common: We have a strong desire to improve our skills. Getting input from colleagues can help us achieve this goal. This column will highlight a wide range of pearls from practicing dermatologists — everything from a better way to perform a clinical procedure to a more effective method for communicating with patients to advice for improving an office function.
Tip 1: Breaking Bad News
I’ve had breast cancer (12 years out). The surgeon was going to give me a call about the results of the pathology test and I knew it would be back by Friday. I didn’t get a call until Monday afternoon and it was the worst weekend of my life. I knew that she would have called me with good news, but guessed that she thought that I could have one more good weekend by waiting until Monday to call. I imagined bad news worse than I got. I now tell people that their spot might be a melanoma. I also tell them it is easier to give good news by telephone rather than bad. I give them a choice of a telephone call from me as soon as I get the report or waiting for the scheduled office visit to review in person. If they decide upon a telephone call, I ask them what they want me to do if they do not answer. I also let them know that I think it is very difficult to leave a message with a spouse that the patient has a diagnosis of melanoma. I tell people that I can just leave a call- back number or leave a detailed message. Most people really want to know as soon as possible and give a personal cell phone number so a spouse won’t get the bad news first. They usually want me to leave a detailed message. Most people are relieved with a telephone call as soon as possible. This plan might be something to consider if you are not breaking bad news this way. Becky Bushong, MD Carmel, IN
Tip 2: The Importance of Catch Phrases
I feel that it is a useful addition to one’s medical practice to have catch phrases for patient encounters. These “lines” can show that you are easygoing and provide for the occasional chuckle. Here are a few that I have picked up over the years from colleagues and some I’ve come up with myself: • On completing the patient encounter: “Well, you’re good for another 10, 000 miles.” • When discussing age spots like seborrheic keratoses: “These are weeds in the garden of life.” • On discharging a patient or returning them to their primary care provider: “Well, you’ve graduated!” • For patients who followed your directions and got better as a result: “Today my friend, you get a gold star.” Benjamin Barankin, MD, FRCPC Toronto, Canada
Tip 3: Managing Cysts
Incision and drainage of infected cysts can be risky to the clinician. Sudden expression of the cyst contents either when being infiltrated with anesthesia, when being incised or when pressure is applied to remove the wall and its contents, can occasionally result in an unwanted spray of material — blood, pus and more. Having a sandwich-type plastic bag on hand to place over the surgical area allows you to clearly be able to see the area to be incised and drained, but also contain potential scatter of contaminated fluids. This is another inexpensive piece of “equipment” in the surgical suite. Sandra Mamis, RPA-C Hudson Valley Dermatology Newburgh, NY
Tip 4: Putting Out Fires
If a patient has frequently recurrent dyshidrotic eczema, I will often explain that they can use a fire-hose treatment like clobetasol cream three to four times per day to put out the fire, and then once the fire is out, to prevent or minimize the number and severity of recurrences by applying topical tacrolimus or pimecrolimus at night time. Benjamin Barankin, MD, FRCPC Toronto, Canada
Tip 5: What Feet Have to do with Treating Hands with Botox
When treating patients’ hands with Botox, the amount of Botox required per hand is proportional to hand size, which is proportional to foot size. So you can tell how much they need over the phone, simply ask patients what size shoes they wear. Very roughly, for a male patient, a • size 8 shoe means each hand needs at least 80 units, • size 10 shoe means each hand needs at least 100 units, • size 12 shoe means each hand needs at least 120 units. So, it is true what they say about guys with big feet... they need more Botox for their hands. Kevin C. Smith, MD, FRCPC Canada Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of five 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.
