Five Ways to Spot Trouble in Your Doctor-Patient Relationship

Doctor and patient.

If you have been going to your dermatologist for the same problem for years, it may be time to find a new one.

If you are getting great results from your acne treatment, a few problems with scheduling or insurance reimbursement or maybe a few less than tactful comments from your dermatologist may be tolerable. But certain practices at your dermatologist’s office spell trouble. Here are five signs that your relationship with your dermatologist may turn into a rocky road and you may want to find another healthcare provider.

1.”Many of my patients have been coming to me for years.”

Back of the age of the kindly general practitioner, it was considered a mark of good medicine to have loyal patients who kept coming back to the same doctor whenever they needed any kind of medical treatment. But if you keep going to the same dermatologist for the same problem for years on end, it is probably worth at least considering whether you are getting adequate treatment.

Some kinds of skin conditions tend to recur. People who don’t get into the habit of using sun protection tend to have to make multiple trips to the dermatologist for treatment of skin cancer.

Some kinds of skin conditions tend to be permanent. If you have psoriasis, Sjögren’s syndrome, or hand eczema, chances are that you will need to see your dermatologist for treatment from time to time for most of your life.

Acne, however, is almost never a life-long condition. Most teens eventually overcome mild to moderate common acne even if they don’t get any treatment at all. Even the more difficult kinds of acne, such as psoriatic acne, acne conglobata, and acne keloidalis nuchae don’t keep causing problems throughout the lifespan. If you have been going to your dermatologist for acne treatment for 10, 20, or 30 years, be sure you know why your condition isn’t curable.

2. Your dermatologist is known for low-price procedures.

Nearly everyone is on the lookout for ways to save money. And since health insurance usually does not pay for treatment of scars and skin discoloration caused by acne, it is sometimes tempting to go to the dermatologist you have heard offers the lowest prices.

Unless you are taking a trip to some cosmetic surgery vacation destination like Buenos Aires in Argentina or San Jose in Costa Rica, it is usually not a good idea to choose your doctor on the basis of price alone. Sometimes the best doctor for your needs charges more, and sometimes less. The important thing is to know what to expect from a procedure and to get the assurances you need that it has the greatest possible chances of working.

Then make a decision on whether you can find room in your budget for the doctor’s fees. If you can’t, don’t try to bargain with the doctor (and absolutely do not make appointments for procedures you can’t pay for). There will be some doctor somewhere who has the professional skills you need who charges a price you can afford. Just look for quality care before you look for affordable care.

3. Your dermatologist doesn’t give you any “face time.”

Doctors who work for HMO’s or who depend on Medicare, Medicaid, or insurance reimbursement are under incredibly pressure to see as many patients as possible. If your doctor only has five minutes to see you, it’s usually not because he or she doesn’t care. It’s because there are a certain number of patients that must be seen each and every day for the clinic to keep the lights on.

Dermatology, however, is a different kind of practice. At least in the United States, most dermatologists earn their income from fees they collect directly from their patients. Your dermatologist is not under as much time pressure as your general practitioner. And you don’t want your cosmetic procedure to be rushed!

Don’t wear out your welcome with your dermatologist. But start looking for a different doctor if your doctor is too busy to answer your questions or the staff is rude.

4. Your doctor encourages you to have multiple procedures for the same cosmetic concern.

Suppose you have a nasty acne scar smack dab in the middle of your brow, advertising the fact that you had bad acne when you were a teenager. And suppose that you went to see a dermatologist about that scar and you were given an injection of a cosmetic filler. You were happy with the results, but you kept an appointment a year later for follow up.

If the dermatologist offers treatments for other cosmetic concerns, consider them. But if in this example you were told that maybe a little more filler to change the slope of your nose or some filler on the sides of your temples would make you look even better, exercise caution. Know the difference between offering other desirable services that perhaps now you can afford and pumping you for major bucks every time you walk in the door.

5. You just don’t have a good feeling about your doctor.

Dermatology is not like some other medical specialties, for instance, brain surgery. If your neurosurgeon doesn’t have a kindly demeanor but does have a great track record of success in performing a procedure you need, you will probably be able to get past the doctor’s lack of bedside manner. If your dermatologist can’t enthusiastically describe the results intended for your treatment, however, something may be wrong.

More than most other medical specialties, dermatology works best when patients and doctors achieve a good rapport. A strictly clinical description of tests, procedures, and results may indicate that the doctor does not understand the quirks and preferences that distinguish you from a “standard” patient—and isn’t the whole point of cosmetic dermatology to bring out your unique good looks, not to make you look like a poor imitation of one of the “beautiful people.”

A good dermatologist can make a tremendous difference in your life for the better. Don’t hesitate to shop around to find the best fit between your doctors abilities and fees and your desires and budget.

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