For Healthcare Professionals Only
Today's dermatology practices serve patients who are all over the age spectrum—from infants to octogenarians (and beyond). Seeing such a broad range of patients and their attendant conditions is challenging for dermatologists and office staff alike, so it's in everyone's interest to find ways to make care go more smoothly for a demographically diverse patient population.
Dermatology practices may be focused on aging baby boomers and projections of the dramatic increase in elderly populations likely to overwhelm the U.S. healthcare system in the coming years. But should patient age be a major consideration when planning appointments?
MEET THE PATIENTS
Unfortunately, you can't prepare for a visit only on the basis of the patient's age, says Elaine DiMaggio, practice manager at North Atlanta Dermatology in Duluth, Ga. Tailoring care to be truly patient centered means practices can't always predict a patient's needs until he comes in. "It has to be done on a case-by-case basis," says DiMaggio. "Whoever needs time gets it, but you don't know who needs it until you meet them." So there may not be a lot to do on this front before a patient walks in the office—once they arrive in the practice, though, a bit of extra care is warranted to accommodate the needs of dermatology patients at different life stages.
In DiMaggio's practice, a medical assistant (MA) meets with the patient first and scopes out any special needs, wants, or concerns that might require concessions or more time. The MA notes things like anxiety or even hearing loss—in the latter case, a note is put in a patient's chart so staff members know to speak a bit more loudly on subsequent visits. DiMaggio says some patients want a procedure done right away, during that day's office visit, so the MA makes sure to alert the dermatologist to those expectations. "We accommodate all of our patients," DiMaggio says. "But you can't do that before they walk in the door."
Stein Berger, practice manager at the Oregon Health & Science University (OHSU) department of dermatology in Portland, agrees. "We treat [patients] according to what they come in for, not how old they are." Outside the clinical angle, however, making the visit more comfortable for patients and improving the customer service element of your practice can indeed be made easier through consideration of such factors.
CREATIVE SCHEDULING
Afternoons tend to be "teen time" in many practices. At North Atlanta Dermatology, teenagers—who are often being seen for acne treatment—are typically scheduled in the afternoon, says DiMaggio. "It's easiest for them to come in after school, so we find that our afternoons have a lot of teens booked in." The dermatologists then know they might be spending more time with a young patient who has a lot of questions about an acne medication or side effects.
"We also get kids who come in to be treated for warts or molluscum and they're scared," says DiMaggio. "We block more time for those things to allow the patient time to calm down and relax." Patricia Tinker, practice manager in the department of dermatology and dermatopathology at the Yale University School of Medicine in New Haven, Conn., adds that babies are typically scheduled for a slightly longer appointment to account for dressing and undressing a wiggling infant. "And other pediatric patients are scheduled for quieter times in the office, just so that kids aren't forced to wait in a crowded, busy waiting room," she says.
SPACE PLANNING
The waiting room is another key to accommodating all kinds of patients. Timothy Cibula, administrator at OHSU's department of dermatology, explains his office's approach: "Right now, we have separate waiting areas for general dermatology and for Mohs surgery patients." This separate Mohs waiting room concept is becoming more common. Because Mohs patients have to wait for long periods, these waiting areas are more lounge-like, with coffee, snacks, television, and lots of reading material. Mohs patients tend to be older, but more and more younger people are having the procedure, so it's not fully accurate to call this an older persons' waiting area—simply remembering to keep in mind the preferences of all the different types of patients who will use each space is the valuable lesson here.
Another common tactic is to have a separate waiting area or a playroom for pediatric patients. "Our waiting area is divided, with a separate section for children," says Tinker. That gives the kids a place to play and blow off steam while they wait, but it also keeps them out of the hair of older patients who might not want to wait in a playroom.
The dermatology department at OHSU is moving to a new building, which will physically separate medical and surgical dermatology. The medical office will also have a separate playroom for pediatric patients. "We find we need to keep the kids occupied," says Cibula. "But we haven't found that they are a nuisance to older patients. A lot of them like having playing children in the waiting room. The playroom is really for the kids' convenience."
In addition to offering engaging diversions, practices that see a high number of pediatric cases may want to take the larger step of hiring a pediatric dermatologist who is also a board-certified pediatrician. Yale has done this, and it's a help, says Tinker. "Our pediatric dermatologist knows kids, not just skin," she says. "He is very good with kids, and that translates to smoother office visits and procedures and happier patients."
BACKUP, PLEASE
Certain categories of patients are more likely to need help from a caregiver. Children, definitely, need parental buy-in for treatment. "Although older kids and teens will often understand perfectly fine about their treatment, we also spend a lot of time with the parents to make sure we have their understanding and cooperation," says DiMaggio. So a dermatologist may well be having two conversations in an office visit (with the patient and with the parent) instead of one, which simply requires a bit more time. Cibula's practice sends out a packet for parents of pediatric dermatology patients along with the initial patient information that goes out when an appointment is booked.
Some elderly patients present special challenges to dermatology practice staff. "We spend some time early in the first visit just assessing how coherent they are," says DiMaggio. Sometimes, if patients have memory lapses or other cognitive impairment, they forget follow-up visits. DiMaggio has implemented a plan under which those patients get a follow-up phone call (or two). When possible, she also contacts a spouse or other caregiver with a reminder. "We try to make sure we have a HIPAA form signed so that there is someone else we can talk to about treatment," she says. This goes for any adult patient—of any age—who would benefit from having a caregiver's help and input.
Although things like waiting rooms and creative scheduling can make dermatology practices run more smoothly, in the end it comes down to treating each patient as an individual, says DiMaggio. "It's more time consuming," she says, "but everyone wants their care and time and attention, no matter how old they are."
This article originally appeared in The Patient-Centered Dermatology Practice newsletter. To register for this complimentary continuing medical education program, which is sponsored by Medical Education Solutions Group (MESG) and supported by an educational grant from Galderma Laboratories, L.P., or to get more information about the series, please call 866 858 7434, e-mail info@mesg.org, or visit www.PatientCenteredPractice.com.
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