SAN DIEGO When Dr. Edward Yob moved to Oklahoma 16 years ago, he became the first physician in that state to perform Mohs surgery. The dermatologists in Oklahoma, however, were not impressed.
They saw no need for such a fancy approach, Dr. Yob said at a meeting sponsored by the American Society for Mohs Surgery.
As a result, he learned to woo a constituency. One practice he has adopted is to take before and after pictures of his cases, and he sends them to the referring physician when he sends the patient back after Mohs, said Dr. Yob, who practices in Tulsa.
He sends the pictures along with a letter and his preprocedure and postprocedure reports. Dr. Yob uses a Nikon CoolPix 990 digital camera because it has a pivot hinge that lets one take pictures at any angle.
One purpose of the pictures is to advertise his skills, but another is to let the referring physicians know that a case does not have to be a huge tumor or be in an intricate location for Mohs referral. Those obviously are not the only cases a Mohs surgeon wants to have to do, Dr. Yob noted.
"It's really just a marketing gimmick, even though that is not all it is," he said. "Show them how you can do small tumors and intricate locations."
The patient records should include a preprocedure report with a diagnosis and location. The postprocedure report should include mention of any special techniques used, anything such as actinic keratoses in the region but left behind, and a histology report.
The operative report should include the Mohs map used during the procedure with a code for the symbols depicting the inking colors used.
When physicians start a Mohs practice, they also need to keep in mind that referrals actually can drop off a little as one becomes established. That is not because one is doing anything wrong. Instead, many areas without a Mohs surgeon can have something of a backlog of cases, and once that backlog gets taken care of, business can drop off a bit, Dr. Yob said.
"Show [referring physicians] how you can do small tumors and intricate locations." DR. YOB