Tip 1: Analogies and Patient Counseling Approaches
Sometimes it is helpful to use analogies and a bit of humor when explaining conditions and treatments to patients. Here are a few examples:
1. When I am convinced that patients have topical steroid-induced rosacea and tell me that they improve with the topical steroids for a short time, I tell them that it is like taking “one step forward and two steps back.”
2. In patients who have a severe atopic dermatitis or other acute or chronic dermatoses, I prefer the “strong, but not long” method and always try to avoid prescribing systemic steroids.
3. Topical 5-fluorouracil and imiquimod are agents that I describe as being “smart bombs.” They go on a “search and destroy mission” and only attack the “bad guys,” cells that are potentially destined to be skin cancers or are already skin cancers.
4. The so-called “dryness” induced by topical retinoids is not dryness, but is actually “exfoliation.” Most patients accept this and are willing to continue its application when I tell them this.
5. Curing warts: I would win the Nobel Prize if I figured out how to cure them.
6. Infant and childhood eczema (atopic dermatitis): Treat the symptoms (eg, itching and lack of sleep) based on how the baby feels and don’t treat the way it “looks.”
7. An isolated, sporadic, dysplastic nevus (mild or no atypia) and no family history of melanoma or the dysplastic nevus syndrome, I always say, “one to a customer.” If more of them appear...make an appointment.
8. Diagnosis: A rash that I cannot explain. Answer: “The body works in mysterious ways.”
Herb Goodheart, MD
Tip 2: Anesthetics and Filler Injections
When injecting lidocaine-containing fillers (eg, Juvéderm XC), it is important to inject a tiny amount of lidocaine as you advance the needle, and do not advance the needle too fast.
That way, the flow of anesthetic-containing filler out of the needle tip will anesthetize the tissue which the needle tip is about to pass through, and you will get the best possible pain reduction.
If you mix the lidocaine in yourself, 2 possible advantages are:
• You will obtain a higher concentration than the 0.3% in the premixed product
• You will thin the product with the water that your anesthetic is dissolved in
The downsides of mixing it yourself are the risks of:
• Contamination of the product
• Degradation of the product due to shear forces during mixing, reducing the duration of cosmetic benefit for the patient. I think this second point is important—since I switched from mixing in lidocaine with Juvéderm to using Juvéderm XC a couple of years ago, I am seeing many more patients who still look really good compared with their pretreatment photos 1 year after injection. This long duration of cosmetic benefit is very good for word-of-mouth, and for patient retention.
Kevin C. Smith, MD, FRCPC
Niagara Falls, ON, Canada
Tip 3: Allergic Contact Dermatitis: Helping Patients Understand
A great analogy with allergic contact dermatitis patients is that if you put your hands in fire, we can help fix your hands. However, if you keep putting your hands in fire, we cannot help you to the same degree until you stop. So prevention is key, and identifying the trigger (eg, through patch testing) is important.
Benjamin Barankin, MD, FRCPC
Toronto, ON, Canada
Dr. Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.