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As any busy dermatologist will tell you, good medical assistants (MAs) are worth their weight in gold. Wait, make that platinum - good medical assistants are really valuable. Who else has the power to make your day run flawlessly, calm restless patients when you're an hour behind schedule, and take care of the myriad details that would bog you down in a hurry if you had to tend to them all?

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Some employees think of the drug sample closet as being free. Fortunately, a written policy can help staff avoid this misconception altogether, as long as it is obeyed.

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Using the Fourth Exam Room (Part 5 of 12)

Thursday, December 15, 2005

Many physicians bog down their workflow by batching a lot of work for the end of the day. When it's finally time to go home, there are charts to dictate, calls to make, and so on. Why not dictate, instead, while you are with the patient?

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Patients choose a dermatologist based on factors such as referral from another provider, subspecialty, and reputation. But experts say patients evaluate based on an entirely different set of standards once they reach the front desk. 

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Practice Management

Office Management With a Purpose: Organizing a Practice Around Skin Cancer Education

Frank Celia

Tuesday, November 07, 2006

Despite two decades of dermatologists advocating the use of sunscreens and the avoidance of sun exposure, the incidence of skin cancer continues to rise. US melanoma rates have more than doubled in the last 30 years, according to the World Health Organization. Worldwide, one in every three cancers is skin-related, and more than a million new cases of skin cancer will be diagnosed in the United States this year, with an estimated 10,000 people dying from the disease, according to American Academy of Dermatology (AAD) figures.

Between 1950 and 2001, the incidence of melanoma increased an astonishing 690% in the United States, and mortalities from the disease rose 165% in that same period, the AAD states. It's no coincidence that those years also witnessed a significant increase in the disposable income and leisure time enjoyed by most classes of American citizens, resulting in increased vacation time and sun exposure.

Dermatologists have no doubt heard these frightening figures before, and they also understand that the majority of morbidity and mortality caused by skin cancers is preventable. This means that they're uniquely positioned to undertake the challenge of convincing people to change their behavior. Practices can strengthen their message to patients by making simple adjustments in the ways that their offices are organized and operated.

In The Waiting Room

Obviously one of the most time-tested methods of reaching patients is through pamphlets to be read while waiting - hopefully not for too long - to be seen. The AAD and the Skin Cancer Foundation both produce literature that covers every aspect of the risks of sun exposure, proper use of sunscreens, importance of self-examination, and summaries of basic dermatologic surgical techniques. These pamphlets are well worth the expense, practice management experts say.

When choosing literature and posters for your waiting and exam rooms, it's important to remember that not all patients will respond to facts regarding the risks of skin cancer. Other tactics are sometimes more effective. Vanity, for example, can be a compelling consideration for some patients. "Oftentimes, I ask patients if they are not really concerned about skin cancer, do they care about wrinkles?", notes New York City dermatologist John A. Carucci, MD. A simple photograph or poster displaying the cosmetic effects of sun-damaged skin can speak volumes in this regard.

Dermatologists should feel free to produce their own patient education materials, too. At her practice in Naples, Fla., Cynthia Yag-Howard, MD, writes up brief index-card messages explaining the pros and cons of the skin-care products available in her practice. Patients may want different qualities in products, and her expert advice can help them find what they're looking for. "Some patients are looking for a creamier-type sun block. Or maybe one for their face that also includes a moisturizer," she says. Rather than rely on product advertising to describe each item, Yag-Howard feels that she can offer her patients a more objective assessment.

Offering Products

Experts agree that skin-care products should be offered to patients, whether in the form of free samples or items for sale. Although the objective should be patient education, not profit, many dermatologists are uncomfortable with this role. But because over-the-counter products are essential in the fight against skin cancer, offering them to patients is a form of sound patient management. Patients respect a dermatologist's expert opinion, and the best way to persuade them to use a product is for a doctor to recommend it, according to practice management consultant Gil Weber, MBA, of Davie, Fla. "It puts the seed in the patient's mind," he notes.

Dermatology practices that really want to be known as patient-friendly might consider gift baskets, says Inga Ellzey, MPA, of the Inga Ellzey Practice Group in Casselberry, Fla. These will be particularly welcomed by patients recovering from skin-cancer surgery. In them, place sunscreens, educational pamphlets, refrigerator magnets displaying the practice's contact information or resource Web sites, or even protective clothing such as hats. Not only does this gesture augment patient education, it lets people know that the practice cares about their welfare, Ellzey adds.

Product samples can also be used to overcome patient objections. For example, because one of the major reasons patients refuse to use sunscreens is the perception that they feel greasy on application, Yag- Howard keeps a particularly cosmetically appealing sunscreen sample in every exam room to prove to skeptical patients that this isn't always the case.

Staff Training

Dermatology office and support staff should know the basics of sun protection and be prepared to convey that knowledge to patients. Monthly inservice training sessions can keep them be aware of new developments in the field, such as the increasing use of spray-tanning products and visits to tanning salons. They should know that there is no safe way to tan, indoors or out, and that spray tans, although not known to present medical risks, do not provide protection against sun exposure.

Make certain that staff know the two most common mistakes associated with sunscreen use: (1) applying a sunscreen once at the beginning of the day, thinking it will provide all-day protection; and (2) not using enough sunscreen to provide adequate protection.

To ensure that staff are communicating effectively with patients, an office manager or dermatologist should occasionally test their knowledge by eavesdropping on their patient interactions or sending in an "undercover" patient to ask questions about the risks of sun exposure.

Other Media

What goes on inside the office is important, but confining your efforts there will limit the message. "Because so many of our patients are being treated for skin cancer, in a way, we are often preaching to the converted," says Carucci. "There is a need to get the message out to the public." Free skin-cancer screenings are a great method of accomplishing this. They can be done in the practice or at nursing homes, apartment complexes, or schools. During the screening, pamphlets and samples can be handed out.

Another way to communicate with the public is through news outlets. Local TV stations and newspapers are often receptive to features on the dangers of sun exposure, especially during the summer months, and may be happy to accept dermatologist-authored news releases.

Less traditional media can also be effective, especially for the Baby Boomer generation, who are at ease with new technologies such as the Internet, according to Ellzey. Dermatologists might consider handing out educational CD-ROMs to patients, as these are relatively inexpensive to produce and can be another way in which to engage patients. Informational videos on display in the waiting area and recorded messages for patients on hold in your telephone system are also potentially effective options.

However it is accomplished, educating patients about the risks of sun exposure represents the linchpin of whatever success dermatology will or will not have in the battle against this prevalent and preventable form of cancer.

Why Educating Patients about Skin Cancer is still Crucial

Dermatologists may feel like they're facing an uphill battle when it comes to educating their patients about the dangers of sun exposure. These US figures provide fuel for continuing the fight:

  • The melanoma rate has more than doubled in the last 30 years.
  • More than a million cases of skin cancer will be diagnosed this year.
  • 10,000 people will likely die from skin cancer in 2006.
  • Between 1950 and 2001, the incidence of melanoma increased by 690%; mortalities from the disease rose 165% in the same period.

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Disclaimer: The material above has been prepared by Physicians Practice. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.