But first….

“Does it bother you?”

It took me a few years to START understanding the importance of this question, but I finally feel like I’m getting the hang of it.

When someone comes in with a rash, irritated mole, or hairloss, the answer to this question is obvious….DUH. Of course it bothers them or else they wouldn’t be here.

But what about the 16-year-old that’s on his phone the entire acne visit?

Or the 10-year-old whose mom wanted you to check out the bumpy skin on the back of her arms?

Can’t forget about the 60-year-old whose wife is driving him crazy about all of the “barnacles” on his back that he didn’t even know were there.

Early on, I would rack my brain about how I could get too-cool-for-school Jimmy to use his acne medications. What fun trick could I come up with to help him remember to use his nighttime topical?!?! What could I do to make his routine easier???

Then, finally, after months of fighting a losing battle, I finally asked him, “Does your acne bother you?”

His response…”Nope.” That was it. I told him to come back and see me if it ever started to. I’ll never forget the look of relief that came over his face.

The same goes for cosmetics. Often, patients will come in for neurotoxin injections and ask, “What do you think I need?”. Nope. Not falling for it.

But for real, I don’t think anyone NEEDS anything. So, I get my mirror out and ask, “What bothers YOU?” Then, we can proceed.

Often, some dermatologic conditions, like keratosis pilaris, may take months of consistent treatment before there is even a glimmer of improvement. So, I’ve learned to be realistic with patients. If it doesn’t bother someone, can I realistically expect them to diligently put a cream on twice a day for 3 months just to start to notice the bumps improving? Probably not. If it does, sure, they’ll probably do it, but you always have to ask that important question first!

Dermatology is one of the few specialties of medicine that allows some room for choice.

Sure, high blood pressure and high cholesterol may not bother you necessarily, but typically, you don’t have a choice but to treat them!

Giving patients a sense of involvement in their care typically results in better outcomes and an overall better experience.

Oh, and Jimmy came back 2 years later and now has clear skin;).