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Clinical Tips: Scabies, Charging, Scheduling, and Counseling

Clinical Tips: Scabies, Charging, Scheduling, and Counseling

Clinical Tips: Scabies...Tip 1: Diagnosing Scabies, the “European” Way
The “European” way of diagnosing scabies is slightly different from the method we teach residents in North America. Rather than blindly scraping the skin and looking for randomly sampled mites and eggs, European dermatologists have a more methodical and efficient approach. The skin on the hands is examined by dermoscopy, in which mites are easily identified as grey-brownish, arrowhead structures. Those living mites can easily be captured by gentle lifting with an ordinary tailor’s pin. If successful, you will notice a tiny, whitish speck, which is the mite clinging to the tip of the pin. Transfer the mite to the microscope slide and enjoy the full view of crawling scabies mite. The diagnosis is unequivocal, quite unlike interpretation of scrapings where mites can be fragmented and the eggs difficult to discern from epidermal fragments.

Dr Robert Gniadecki
Edmonton, Alberta, Canada

Tip 2: Charge by the Procedure
In charging for any botulinum toxin treatment area, most colleagues charge by the number of units of toxin used. Others have made the point that we have been brainwashed by the producers of the agents we use. There is no reason we should be wedded to the product we use any more than we should charge surgeries by the number of sutures used.

Charging by the procedure, no matter how much product is used, is more logical, equitable, and profitable. It’s what I now do.

Dr Gerald Bock
Germantown, TN

Tip 3: Patient Self-Photograph
Have your patient photograph their own moles/lesions on their mobile phone, especially if they are going to a different physician/surgeon to cut it out or if you have treated or biopsied it already. Patients always have their mobile phone on them, so there is no issue with them forgetting their camera or prints.

Dr Benjamin Barankin
Toronto, Ontario, Canada

Tip 4: Scheduling
We stagger lunch breaks for staff; some go earlier and some go later to accommodate patients leaving later and coming earlier. Those who come to work early get to leave early, whereas those who choose to come later, stay later. To keep scheduling smooth, we also keep the local school system calendar in front of each receptionist. Our staff and the patient can refer to it when scheduling to reduce the odds of no-shows or last- minute cancellations.

Dr Jane Chew
Columbia, MD

Tip 5: Counsel Patients on Off-Label Usage
When there are no FDA-approved treatments for a condition (eg, molluscum, alopecia areata), be sure to explain this shortcoming and that we are going to do our best, based on the literature and experience, to try to help the patient nonetheless.

Dr Seth Orlow
New York City, NY

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