Office Management With a Purpose: Organizing a Practice Around Skin Cancer Education
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
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
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.
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,
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.
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
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.
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
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
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
- The melanoma rate has more than doubled in the last 30
- More than a million cases of skin cancer will be diagnosed this
- 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