User login
I thought I'd seen it all, until Jack took off his shirt. On his chest, back, and arms were a dozen round stickers, each the canary color of smiley faces. What now? Day-Glo nicotine patches?
Jack explained. "The last time you took off my age spots," he said, "you missed a few. So I marked them." Sure enough, next to each sticker a brown excrescence glared like a crusty reproach. No way would I miss those babies this time.
Now I was back on familiar ground. Over the years, I've seen patients mark spots that concern them with ink dots, ink circles, mascara circles, crude but elaborate anatomical drawings studded with dots (I keep some in my files - they could be worth something some day), and narrative descriptions written in the style of treasure maps, ("Go 3 inches above the left third knuckle, turn right.")
This is not satire. This is life.
Many patients have obsessional tendencies and they show up with lists - of questions, of spots - which they absolutely must get through before life can go on. One or two such patients can be amusing, annoying, challenging, or maddening. Three in a row, and I need a stiff scotch.
When it comes to concerns about spots, the distinction between "medical" and "cosmetic" is irrelevant. It matters not whether the offending spots are skin tags, warts, or actinic keratoses.
People point to and lovingly massage each one in turn, because the spot mars their surface and offends them the same way a piece of tomato hanging off your dining partner's lip may offend you, or a run in your pantyhose, or a scratch on the hood of your shiny new car. The lip, stocking, and the car work just fine, but there's a spot, and you've got to get it off!
Over the years, I've developed strategies to deal with patients with lists of spots or questions.
Get hold of that list! Gently extract the slip of paper, and tick off the items one by one. This helps spare your anxious patient the chore of rereading over and over the ones you already covered, fearful that you missed one.
Wait until the list is done. This may be hard, especially if the list is memorized and you don't know how long it's going to be.
You can tell a lot by body language, however. As you go from point to point, or spot to spot, patients will stay tense and hunched over, with a look of fear and anxiety lest something get skipped. Trying to wrap things up before they're done will make them angry and resentful. Thus distracted, they may forget one, then call or return with a reproachful, "You missed a spot!" Actually, many patients soften their critique by saying, "I think we missed a spot." We're in this together!
Be specific. Don't just look at the back and say, "Everything here looks all right." Instead, point at each spot in particular and comment on it. You must specify that you saw exactly what was worrying the patient (or spouse) and announce that it doesn't worry you.
For especially obsessive people, I advise using this three-part formula: "I am looking at this spot. I can see it. And it's okay." Only when you say all three - in order! -will your patient relax.
Have patients mark their spots at home. Even laid-back people can't find what they're looking for and become anxious and agitated when an impatient, white-coated figure is standing over them with a spray can of liquid nitrogen or an electric needle. That to them is a guarantee you'll miss a spot. (Okay, both of you will miss the spot.)
If patients want you to scour their integument on a search-and-destroy mission, ask them to spend a few minutes the night before in the comfort of their own bedroom marking off what they want done or looked at. That way they can't blame you for sloppiness. Tell them they can use ink, marker, or mascara. Or even yellow stickers.
Editor's Note: This column first appeared in "Skin & Allergy News" in February 1999. This column, along with other "Under My Skin" columns, will be featured in Dr. Rockoff's book, "Under My Skin: A Dermatologist Looks at His Profession and His Patients." It will be available through sites like Amazon. Dr. Rockoff will donate all author royalties for books bought by dermatologists to Camp Discovery.
I thought I'd seen it all, until Jack took off his shirt. On his chest, back, and arms were a dozen round stickers, each the canary color of smiley faces. What now? Day-Glo nicotine patches?
Jack explained. "The last time you took off my age spots," he said, "you missed a few. So I marked them." Sure enough, next to each sticker a brown excrescence glared like a crusty reproach. No way would I miss those babies this time.
Now I was back on familiar ground. Over the years, I've seen patients mark spots that concern them with ink dots, ink circles, mascara circles, crude but elaborate anatomical drawings studded with dots (I keep some in my files - they could be worth something some day), and narrative descriptions written in the style of treasure maps, ("Go 3 inches above the left third knuckle, turn right.")
This is not satire. This is life.
Many patients have obsessional tendencies and they show up with lists - of questions, of spots - which they absolutely must get through before life can go on. One or two such patients can be amusing, annoying, challenging, or maddening. Three in a row, and I need a stiff scotch.
When it comes to concerns about spots, the distinction between "medical" and "cosmetic" is irrelevant. It matters not whether the offending spots are skin tags, warts, or actinic keratoses.
People point to and lovingly massage each one in turn, because the spot mars their surface and offends them the same way a piece of tomato hanging off your dining partner's lip may offend you, or a run in your pantyhose, or a scratch on the hood of your shiny new car. The lip, stocking, and the car work just fine, but there's a spot, and you've got to get it off!
Over the years, I've developed strategies to deal with patients with lists of spots or questions.
Get hold of that list! Gently extract the slip of paper, and tick off the items one by one. This helps spare your anxious patient the chore of rereading over and over the ones you already covered, fearful that you missed one.
Wait until the list is done. This may be hard, especially if the list is memorized and you don't know how long it's going to be.
You can tell a lot by body language, however. As you go from point to point, or spot to spot, patients will stay tense and hunched over, with a look of fear and anxiety lest something get skipped. Trying to wrap things up before they're done will make them angry and resentful. Thus distracted, they may forget one, then call or return with a reproachful, "You missed a spot!" Actually, many patients soften their critique by saying, "I think we missed a spot." We're in this together!
Be specific. Don't just look at the back and say, "Everything here looks all right." Instead, point at each spot in particular and comment on it. You must specify that you saw exactly what was worrying the patient (or spouse) and announce that it doesn't worry you.
For especially obsessive people, I advise using this three-part formula: "I am looking at this spot. I can see it. And it's okay." Only when you say all three - in order! -will your patient relax.
Have patients mark their spots at home. Even laid-back people can't find what they're looking for and become anxious and agitated when an impatient, white-coated figure is standing over them with a spray can of liquid nitrogen or an electric needle. That to them is a guarantee you'll miss a spot. (Okay, both of you will miss the spot.)
If patients want you to scour their integument on a search-and-destroy mission, ask them to spend a few minutes the night before in the comfort of their own bedroom marking off what they want done or looked at. That way they can't blame you for sloppiness. Tell them they can use ink, marker, or mascara. Or even yellow stickers.
Editor's Note: This column first appeared in "Skin & Allergy News" in February 1999. This column, along with other "Under My Skin" columns, will be featured in Dr. Rockoff's book, "Under My Skin: A Dermatologist Looks at His Profession and His Patients." It will be available through sites like Amazon. Dr. Rockoff will donate all author royalties for books bought by dermatologists to Camp Discovery.
I thought I'd seen it all, until Jack took off his shirt. On his chest, back, and arms were a dozen round stickers, each the canary color of smiley faces. What now? Day-Glo nicotine patches?
Jack explained. "The last time you took off my age spots," he said, "you missed a few. So I marked them." Sure enough, next to each sticker a brown excrescence glared like a crusty reproach. No way would I miss those babies this time.
Now I was back on familiar ground. Over the years, I've seen patients mark spots that concern them with ink dots, ink circles, mascara circles, crude but elaborate anatomical drawings studded with dots (I keep some in my files - they could be worth something some day), and narrative descriptions written in the style of treasure maps, ("Go 3 inches above the left third knuckle, turn right.")
This is not satire. This is life.
Many patients have obsessional tendencies and they show up with lists - of questions, of spots - which they absolutely must get through before life can go on. One or two such patients can be amusing, annoying, challenging, or maddening. Three in a row, and I need a stiff scotch.
When it comes to concerns about spots, the distinction between "medical" and "cosmetic" is irrelevant. It matters not whether the offending spots are skin tags, warts, or actinic keratoses.
People point to and lovingly massage each one in turn, because the spot mars their surface and offends them the same way a piece of tomato hanging off your dining partner's lip may offend you, or a run in your pantyhose, or a scratch on the hood of your shiny new car. The lip, stocking, and the car work just fine, but there's a spot, and you've got to get it off!
Over the years, I've developed strategies to deal with patients with lists of spots or questions.
Get hold of that list! Gently extract the slip of paper, and tick off the items one by one. This helps spare your anxious patient the chore of rereading over and over the ones you already covered, fearful that you missed one.
Wait until the list is done. This may be hard, especially if the list is memorized and you don't know how long it's going to be.
You can tell a lot by body language, however. As you go from point to point, or spot to spot, patients will stay tense and hunched over, with a look of fear and anxiety lest something get skipped. Trying to wrap things up before they're done will make them angry and resentful. Thus distracted, they may forget one, then call or return with a reproachful, "You missed a spot!" Actually, many patients soften their critique by saying, "I think we missed a spot." We're in this together!
Be specific. Don't just look at the back and say, "Everything here looks all right." Instead, point at each spot in particular and comment on it. You must specify that you saw exactly what was worrying the patient (or spouse) and announce that it doesn't worry you.
For especially obsessive people, I advise using this three-part formula: "I am looking at this spot. I can see it. And it's okay." Only when you say all three - in order! -will your patient relax.
Have patients mark their spots at home. Even laid-back people can't find what they're looking for and become anxious and agitated when an impatient, white-coated figure is standing over them with a spray can of liquid nitrogen or an electric needle. That to them is a guarantee you'll miss a spot. (Okay, both of you will miss the spot.)
If patients want you to scour their integument on a search-and-destroy mission, ask them to spend a few minutes the night before in the comfort of their own bedroom marking off what they want done or looked at. That way they can't blame you for sloppiness. Tell them they can use ink, marker, or mascara. Or even yellow stickers.
Editor's Note: This column first appeared in "Skin & Allergy News" in February 1999. This column, along with other "Under My Skin" columns, will be featured in Dr. Rockoff's book, "Under My Skin: A Dermatologist Looks at His Profession and His Patients." It will be available through sites like Amazon. Dr. Rockoff will donate all author royalties for books bought by dermatologists to Camp Discovery.