Page 8 – Ethicare Remedies

Topical Steroid Damaged/Dependent Face

Dermatology was once an army with only one weapon – the steroid to tackle so many dermatological diseases. Of course, it has the big advantage of direct drug delivery to the disease site with no systemic side effects. Still TCs are pivotal in every dermatologist’s armory. Anything over-used tends to get more chances of being abused.

The most widely over-used / misused topical agent over face is undoubtedly steroids for a wide range of on and off labeled indications. A number of steroid molecules from least to super potent are misused by the over-the-counter sales and non-dermatologist prescribers. The resultant cutaneous damage in face has varied clinical manifestations.

Facial Skin and Vulnerability:

Certain features that render skin over the face more susceptible to ill-effects of steroids:

Thinner than other parts
Drug absorption is more owing to rich blood supply
More exposed to sunlight: photodamage is collateral
Succumb more to environmental pollutants
Concomitant usage of various cosmeticeucals

Clinical Features:

Some describe the changes as “topical steroid damaged/dependent face – TSDF”. Face can have one or many of the clinical presentations among the following: erythema, hyperpigmantation, papules, pustules, nodules, telengiectasia, photosensitive rash, striae, hypopigmentation (rare).

The two specific hallmark features of steroid abuse that make it difficult to convince the patient and need a lot of counseling are:

Increase in symptoms after withdrawal especially increase in erythema and scaling
Cyclical pattern of remission and relapse for a period of time (varies with individual patient): they respond to treatment for quite some time interspersed with sudden flares while on treatment followed by clearance and this cycle gets repeated till complete cure.

Management:

Intense moisturisation and adequate sun protection are the mainstay of management. Frequent application of moisturizers should be advised. Sunscreens should be chosen wisely. They should be non comedogenic, hypoallergenic and pH balanced.

Various other treatment options have been tried including topical metronidazole and azoles to counter the altered microbial flora and malassezia over growth owing to steroid induced immunosuppression. Topical hyaluronic acid formulations help skin repair. After adequate skin rejuvenation, various alpha and beta hydroxy acid preparations help in reducing pigmentation that include glycolic acid, kojic acid , mandelic acid and their combinations. Topical glutathione can be of help. Chemical peels and Intense pulse light may be included in treatment but not on acute phase.*-*-*

MRSA Infections: Are they relevant in the Indian context?

Celbenin, or methicillin, which was discovered by Beecham in 1961, was touted then as the ultimate staphylococcidal, being effective against penicillinase producing strains, but soon after, strains resistant to it were also discovered, initially in the hospital setup, and later, in the community setup. This organism, christened as Methicillin Resistant Staphylococcus Aureus, or MRSA, has gone on to become a scourge in recent times. Western literature, especially from the US, is rife with reports of morbidity and mortality from this particularly aggressive organism.

There has been a gradual increase in the number of reports describing MRSA in India over the years. Varied rates of MRSA infection have been reported, from rural to urban, from pediatric to geriatric, and from simple skin infections to serious sepsis cases, in the Indian medical literature of late. Several studies have reported the prevalence of MRSA in healthcare workers, particularly among those who were involved in critical care areas, as between 10 and 14.3%. The isolation rates for MRSA from outpatients, ward inpatients and intensive care units (ICUs) were 27%, 49% and 47%, respectively, in studies reported in 2009. The majority of S. aureus isolates were obtained from patients with skin and soft tissue infections, followed by those suffering from bloodstream infections and respiratory infections. According to a recent study, the frequency of 45% of S. aureus clinical isolates being methicillin-resistant in India in the early 2010s is similar to what has been reported in the rest of the Asian countries (41.9% in Pakistan, 45.8% in China, 41% in Japan, 35.3% in Singapore and 55.9% in Taiwan), except Hong Kong, Indonesia (28% each) and South Korea (>70%). Similar to global trends, however, MRSA in India has been observed to be of geographically diverse origins.

Initial studies of clinical samples from hospitals showed that the incidence of the hospital acquired organism, HA-MRSA was as low as 6.9% in 1988, but increased to 27% to 47%, across several cities, by the late 1990s. Infections with the community acquired CA-MRSA have been reported in school children and in healthy individuals both from rural and urban areas.

The first report of characterization of CA-MRSA from India was for an isolate obtained from a patient suffering from osteomyelitis, pyomyositis and pneumonia in Bengaluru. The strain was found to be of the Sequence Type ST772, also called the Bengal Bay clone. A recent study investigating clinical samples from inpatients (from Bengaluru, Mumbai, Hyderabad and Delhi) as well as nasal carriage by rural and urban healthy volunteers revealed that ST22 and ST772 were the dominant MRSA clones. It was also noted that other minor clones belonging to ST1208 (CC8) and ST672 were emerging. The majority of the isolates also carried genes for Panton Valentine Leukocidin as well as many other toxins. It is noteworthy that CA-MRSA clone ST772 is rare in other Asian countries.

In addition to ST772 and ST22, another new emerging clone, ST672, which has not been reported elsewhere in Asia, has been isolated primarily from India. This organism has been found to be transferred across the globe by travellers from India. In a study titled “Airport Door Handles and the Global Spread of Antimicrobial-resistant Bacteria: A Cross Sectional Study”, published in Clinical Microbiology and Infection last year, Frieder Schaumburg (University Hospital Münster, Germany), the lead author, notes that 400 toilet door handles in 136 airports in 59 countries were sampled and found to harbour the ST672 strains. 60% of the samples were taken in the men’s room with 40% in the women’s toilets and, on average, the time between sampling and culture in the lab was seven days. Samples were taken in the airport of arrival (80.75%) a stop-off point (2.75%), or the destination (16.5%), and the results make fascinating reading.

In the light of the aforesaid findings, the awareness of the existence of this organism, and its special strains in India, is a must amongst Dermatologists, since it is we, along with the surgeons, who encounter them most often. The susceptibility of this organism to our older antibiotics Doxycycline, Co-trimoxazole and Clindamycin, and Fusidic acid, particularly in the community setup is a heartening point to note. The HA strains, if they do not respond to the already mentioned antibacterials, will have to be treated with the newer antibiotics, viz., Ceftaroline, ceftobiprole, tidezolid, dalbavancin, otrivancin, or a combination of beta lactamase with vancomycin or daptomycin.:)

How to choose the right book which is worthy of your time?

“BOOKS ARE THE SECOND BEST FRIEND OF HUMAN BEING

JUST NEXT TO HAVING A REAL FRIEND WITH YOU.”

In the previous issue of DERMATALK, we had conducted a survey by asking a question ‘How do you increase your knowledge other than your academic knowledge?’

In response to this question, we received many interesting inputs. Topping the list were these three: by attending conference, by communicating with colleagues and internet surfing. While reading books, listening to audio books and watching learning videos were at bottom of the list with the respondents. However when I analyze my learning pattern, it reflects the opposite (books, audio books and learning videos are top of the list). After my article and tips in the previous issue of Dermatalk, I received several e-mails from various dermatologists seeking suggestions for good books on various topics like leadership, marketing and negotiation. As I responded them it evoked a thought in my mind why not to share the guidelines of how to choose a book which is worthy of your time.

Before we get into the guidelines, let us understand the primary purpose of reading.

It can be categorized under the following 4 factors:

Reading for Entertainment:

This is a different genre which we do not discuss here since it is unrelated to the aim of this article.

Reading for Inspiration:

Considering the position where you and I have reached, we ought to be self inspired, so I will shelve this category too.

Reading for Information (How to…books):

The best investment of time is to read maximum number of blogs, books etc. on informative articles. One such example of informative reading can be this article

Reading for Knowledge:

It is understood that you are investing a huge amount of time in acquiring and increasing your academic knowledge. But if we talk about the subjects like Leadership, Entrepreneurship, Management, Marketing, Sales, and Negotiation etc.; these topics are not taught in the medical college. All doctors need to acquire this knowledge on their own.

This is what this article is all about.

Here are some guidelines which will help to

choose a book worthy of your time:

People say that never judge a book by its cover. However I believe that ‘One should judge a book by its cover too.’ The cover reveals many facets of the book. It also gives you an idea whether the quality of the content and the relevance of subject matter match our requirement.
You get a good idea about the book by its title, subtitle and the text written on the cover page.
The author’s biography is generally written somewhere on the flip side of the cover page. Glancing through his biography and his previous work will help you understand what is in store for you in the book.
Reading testimonials, about the book and the author, will assist you in deciding whether the content is worth investing your time.
If the book is divided into sub-topics, you can gauge the weightage given to each subtopic by the pages allocated to each topic and that way you can come to know the depth of each covered topic because sometimes the topic which you are inclined to would have been discussed superficially with less pages while other topics would have been discussed in depth which may not be of your interest.
Reading online review of books is also a good source of the information.
Randomly go through a few pages to get a glimpse of content and see if the content engages you and interests you or not.
Friend and peers recommendation is also a helping hand to choose a good book.
Highlights, colour-coding, quotes, images, chart sand bold captions in the book gets a thumbs up from me while choosing a book as it gives essence of the book in less time.
A take home message, summary of the chapter at the end of the chapter gives you food for thought and which helps instant cementing the knowledge which you just grabbed from the chapter.
Some short exercise or thought provoking questions at the end of chapter also helps you to instantly put the knowledge in practice which you just acquired.
In the FOREWORD or PREFACE section of the book, a brief about the topic of the book is given. This helps us in inferring the soul of the book.
Font size, font type, printing and paper quality and the language used are also important deciding factors. They hold an aesthetic appeal which enables us to read smoothly and keep us engaged.
(Last…And the least 🙂 The price of the book in my case is of least importance because as the old adage goes, ‘a good book is worth a thousand friends’ – believe me when I say that any book can give you insightful information if you have got a learner’s attitude while reading. Even a single point grasped and implemented properly would be worth the price of the book. In my library of about 1200 books I have got a wide range of the books costing 60 Rupees to 7000 Rupees and in my opinion they all are worth the investment.

Hope this article helps to choose a right book which is worthy of your time for subjects like entrepreneurship, leadership, negotiation, marketing, team building etc. This is my contribution to build a better community of superior readers.

(P.S. No matter however hard we try, there is always a chance of selecting a wrong book once in a while. What do you do then? As for me, I never feel guilty to put a book aside if I find the book uninteresting and irrelevant during the course of reading. I put that book aside without feeling burdened and start exploring new avenues. You too can do the same without feeling guilty 🙂

EXPERTS SPEAK

After getting amazing feedbacks and comments for Dermatalk’s innovative and insightful segment “Expert speak” where we discuss important aspects with different experts, share their insights and ideas on various important aspects. This section mainly focusses on non medical issues and those which will be immensely useful to our readers.

In this issue, we are privileged to have Dr. C.P. Thajudheen, Dr. Jagdish Sakhiya, Dr. Amit Karkhanis and Dr. Pranav Pancholi as experts to share their precious experience and opinion. A Big thanks to them.

ROADMAP OF RUNNING CHAIN OF CLINICS IN INDIA

Running a chain of clinics is everyone’s dream and desire. However very few have been able to make this dream a reality. These few are definitely doing something right and something different that others are not doing. So, we have chosen 4 highly successful, established and experienced cosmetologists & dermatologists-entrepreneurs from across the India and from Kenya to share their journey to success, the hardships as well as their future plans. Dr. C.P. Thajudheen is definitely the king of south and has a roaring cosmetic practice in Kerala. Dr. Amit Karkhanis has established himself a name in Mumbai. Dr. Jagdish Sakhiya needs no introduction and is on the way to mark a century. Looking overseas we have on board Dr. Pranav Pancholi from kenya and he shares his practice secrets with us here.

Undoubtedly, HUMAN RESOURCE is the most important aspect in success of any business and this applies to cosmetic clinics as well. Being a service industry, training of the staff, their constant development, their grooming and most importantly their retention is a very challenging task.

NOW LET’S HEAR FROM OUR EXPERTS HOW DO THEY DEVELOP & RETAIN THEIR STAFF MEMBERS?

Dr. Jagdish Sakhiya says – to develop and retain our staff we regularly do staff assessment and give regular training both technical and personal development. We do in-house and also invite various faculty from management and related industry persons to train them.

Dr. Amit Karkhanis also add that We have continued staff training program. Responsibility given to them to handle their own respective functions.

Dr. Thajudheen says – we conduct induction class, give them training and awareness about all departments in clinic. We provide positive working atmosphere and regularly take employee opinion survey as well as conduct one on one meeting to discuss the various things. Also, we have good salary package, PF, ESI and insurance. “Appreciation increases employee happiness and satisfaction, it improves company culture” So we appreciate their work regularly. We also communicate our new business mission with our employees.

Dr. Pranav Pancholi – Yes, we do regular training sessions for technical, marketing as well as personal growth for our team. We provide incentive based salary and give commission to motivate them.

AS we know that chain of clinics would be in different cities, states and countries and the no. of clinic would be regularly increasing…so the biggest challenge is

HOW TO RUN AND MANAGE CHAIN OF CLINICS & HOW TO FACE THOSE CHALLENGES?

As per our expert

Dr. Amit Karkhanis says – my biggest challenges, our Clients ask to meet the main Doctors and this requires a proper handling and management.

For that we have proper STANDARD OPERATING PROCEDURES, it is the keys to developing a chain of clinics and maintaining the same.

Dr. Jagdish Sakhiya says our biggest challenges, we face in terms of attachment of medical doctors for long period and also trained staff from same field.

To overcome these challenges, we are maintaining proper relationship & conducting motivational programme. We provide them world’s best facilities, lasers, equipment’s & technologies. We also offer incentive and commission with good package. We provide proper training to our staff as per our field requirement.

Dr. Pranav Pancholi – my challenges to maintain Human resource and mismanagement.

For that we conduct regular staff motivation in terms of various things to develop them and creating system to avoid mismanagement.

Dr. Thajudheen says – Attrition and Pilferage are the biggest challenges with chain of clinics

To overcome, we regular monitoring CCTV in branches very efficiently, and we make doctors involve in all the clinic activities more & more. We offer them good packages, PF, ESI, insurance and appreciation.

Now we want to know from our experts about

2 MAJOR HURDLES WHEN THEY DECIDED TO BRANCH OUT AT THE TIME OF APPROACHING TO OPEN THEIR SECOND CLINIC.

Dr. Thajudheen – My 2 major hurdles were Language & Doctors availability

Dr. Pranav Pancholi says – it was accountability and human resource constraint

Dr. Amit Karkhanis – my major hurdles during branch out were

Clients identifying the brand with a Doctor.
Identifying the correct staff and location for the branch expansion

Dr. Jagdish Sakhiya’s 2 major hurdles were to

Find trained staff at that time
Long breakeven point.

One very good question to all over experts

IF YOU ARE TO START YOUR JOURNEY AS A DERMATOLOGIST ALL OVER AGAIN WOULD YOU CHOOSE TO OPEN CHAIN OF CLINIC?

Dr. Amit Karkhanis says – Of course. The objectives and results are very different in running an individual clinic and a chain of clinics. Its 2 different ‘games’ so choose wisely and correctly. I enjoy difference challenges and the clinic chain was the second challenge after doing the first one very well. Now we have moved to the 3^rd challenge!

Dr. Jagdish Sakhiya also says yes, definitely, I choose to open chain of clinic

Dr. Pranav Pancholi adds – Yes, I choose to even more clinics with set up and systems.

Here as per Dr. Thajudheen’s opinion– yes I chose to open but I would rather go for franchise model.

Going private, consolidation, breaking into new markets with new services – there are all kinds of reasons for companies to Acquire and Merger with the other firms in coming years. Expecting lots of M&A activity that we have seen several big deals signaling new products, services and capabilities coming to the market for our industries.

So according to current scenario, we ask our experts to state their opinion on

“IS THE FUTURE OF DERMATOLOGY PRACTICE MERGERS AND ACQUISITIONS?”

As per Dr. Amit Karkhanis’s opinion – Yes. With corporatization taking place in healthcare, Mergers and Acquisitions would a part of the future, but it will take some time in India, which will for the next 7 years at least always have a market for individual Doctor Clinics in the Dermatology segment.

Dr. Thajudheen’s opinion – Yes, Mergers and Acquisitions will give the synergy in our industry

Dr. Pranav Pancholi – That shall be the case I believe, going forward as the market expands… I plan to buy clinics of retiring doctors.

Dr. Jagdish Sakhiya says – in our dermatology segment Mergers and Acquisitions – not in coming 5 years

We want to know from our experts, about their

10 YEARS FORWARD FUTURE PROJECTION.

Dr. Pranav Pancholi from Kenya – my future projection is, to have an international chain of clinics all across Africa.

Dr. Jagdish Sakhiya says, my future projection is, by 2026, Sakhiya Skin Clinic will have 60,000 square feet corporate office and training center in Surat. We will have our presence in all Tier-I, Tier-II and Tier-III cities on the world map well. Sakhiya Skin Clinic will be leader in Aesthetic Dermatologist and Plastic Surgeries.

Also, we will have our own Sakhiya Remedies Pharmaceutical production unit producing world-class skin and hair care products.

Dr. Amit Karkhanis says – Would not like to specifically comment, but we see ourselves with 150+ clinics across with worldwide operations across 5 continents.

In future, Dr. Thajudheen says I would like to plan Franchise model

TO BRANCH OUT CHAIN OF CLINIC, WHAT ARE THE 2 IMPORTANT CAUTIONS YOU WOULD LIKE TO SHARE WITH YOUNG STARTUPS & FELLOW COLLEAGUES

Dr. Jagdish Sakhiya:

Updated your knowledge continuously & best patient care
Patience for long breakeven point & make command fund to take care of any emergency situation.

Dr. Thajudheen shares, “Be ethical & Take time to give proper counseling”

Dr. Amit Karkhanis:

Do what you enjoy. Technology was something that I was always comfortable with from childhood, so get your comfort zone right in your choice of work. Getting the right technology into my clinic from the early stages was an important piece of our foundation, yours might be something different.
Innovate Well and always treat all people around you right.

Dr. Pranav Pancholi advices, “Be careful but confident and start slow with a vision to expand”

ONE SINGLE MOST PERSONAL MANTRA, MISSION OR VISION IN ONE SENTENCE.

Dr. Thajudheen:

Professionalism and Ethics

Dr. Pranav Pancholi:

The possibilities in aesthetic dermatology are endless when one has a clear vision and follows the right path.

Dr. Jagdish Sakhiya:

My aim is to provide world class services at affordable price to every Indians.

Dr. Amit Karkhanis:

Work Hard, Play Hard, Constantly Innovate and Always try New Things!

Conclusion…..

We have no doubts that the cosmetic and wellness industry in 2017 is a booming industry and anyone associated in any way with this industry is definitely in the right place. Last decade has seen a tremendous growth in terms of chain of clinics, new technologies, mergers and acquisitions of healthcare giants as well as numerous ecommerce website business flourishing. This era can clearly be marked as the golden period of the cosmetic industry and is here to stay.

What is very characteristic from the above thoughts of the experts is that for all of them, challenges were similar and single most challenge that everyone faces is staff attrition. However they all believe that they were born for this trade and love their work. So for all those established practitioners and even the new comers, in case you have any inkling for running a chain of clinics in future, you need to don your entrepreneur cap and get set.

Great Leadership -The Master Stroke To Thrive In Your Practice

“Everything in life rises and falls on leadership.”
– John C. Maxwell

Having interacted with end number of people including doctors led me to the conclusion of people having weak or incomplete definition in their mind and when the soil of foundation is not concrete enough – one cannot build a solid dependable structure on that. We, being in the medical profession have not learned much about leadership. However, it is also a fact that everything including my businesses and your practice rise and fall on leadership.

“Leadership is all about influencing, nothing more nothing less.”

To make this concept easier to understand, let me explain you few
more things:

1. When it comes to leadership, this influence is positive rather than negative.
2. Leadership is not about being number 1 (OPD wise or income wise) dermatologist of your area. (Even though this is the most perceived popular definition of leadership but this is not complete)
3. This influence is not confined only to your peers
4. This influence is in terms of your patients, your team-members, the medical representatives whom you meet to, your pharmacy, your vendors (laser machine vendors, medicine vendors, IT professionals etc.) and the people referring you patients (doctors, patients, friends, relatives, medical shop owners, paramedical people etc.).

In a nut shell – how much and how far positively you influence your surrounding plays a vital role in developing and establishing your practice.

“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”
– John Quincy Adams

Now let us have a look at the things which can help you to inspire and influence people and which way you can inspire and influence all the people who matter most to you.

“A great reader may not be a great leader but all great leaders are great readers.”

The first and foremost tool which will help you to influence others and lead others is your knowledge and abundant knowledge will only come through consistently reading great books on diverse topics. The more number of people perceive you an accountable, reliable resource for their development and getting advice from you in the more diverse subjects and topics, the more your influence will be in their life. This is possible through becoming a serious reader on diverse topics so great leaders are great readers. They read great books not only on their academic subjects only but also on other subjects like sales, leadership, productivity, human psychology, time management etc. This helps you in becoming a leader by providing great values in various subjects to the people whom you get in touch with.

Leaders develop other leaders. One of the key factors of being a great leader is developing more leaders. While many people believe that it is all about developing more followers while the truth is – a great leadership is all about developing other leaders. That means it is significant how many other people’s lives you impact and for how many more people you become inspirations for them becoming a leader in their own small world. If we connect this to typical dermatology practice, to how many more dermatologists you are developing and becoming a role model, to how many more patients you are inspiring on various aspects including living their life comfortably with their chronic ailments, to how your staff members feel enlightened and feel joyful working with you, to how great care you take care of your people who refer you patients (please note this is not about monetary part), to what is your intention behind doing all these and sharing your knowledge with other people through conferences or workshops and articles – these all play a vital role in heading your leadership to a great height and as a result thriving in your practice.

The same theory of leadership applies in dealing with your different kind of vendors. How you are inspiring and impacting their lives in a positive manner determines – how they look at you, what type of deal they offer you – subsequently based on that how much you can thrive in your practice.

Even though leadership is a vast subject, having end numbers of books published on this single topic, I tried to give a brief idea about leadership and how it can help you in your practice. Feel free to write to me ([email protected]) if you would like to have some name of great books on leadership which would be of great help to become an amazing leader.

Which other topics you are thinking of exploring to extend your knowledge after reading this article?

Connect with Mr. Ilesh Khakhkhar

Useful Tips for Junior Derms -1: Develop a Robust Bond with Patients

Any doctor passing out of his alma mater, be it the MBBS, MS or MD/ DVD, the general impression is that once the university grants a degree and there is reasonable amount of confidence, he or she is ready for private practice. Having found a rented space or own premises, the neo-dermatologist is ready to test his skills at treating patients on his own! The volume of practice any physician develops in the first few years is directly proportional to the ability to retain patients. It would be wise to remember that in dermatology, this is all the more important.

Understand one’s speciality:
Every physician needs to essentially understand the limitations of his/her speciality. One cannot forget that dermatology as a specialty deals predominantly with disorders which are chronic, recurrent and sometimes incurable. As a result the patient has to keep revisiting the dermatologist several times to get a reasonable degree of improvement.
Besides, many conditions are related to the environment or lifestyle which cannot be altered greatly. For example, a vegetable vendor who is suffering from a photosensitive disorder cannot maintain sun-protection all the time due to which the dermatosis is bound to recur. In such a scenario, the frustration of the patient rises with each follow up visit which may lead to loss of faith in the doctor, although it is not his doctor’s fault! Therefore, it is very important to develop a strong bond with the patient so that he/she feels that you are genuinely trying to help him/her.

Strength of bond:
It is well known that at any time of the day outside some physician/specialist’s consulting rooms, there is always a huge crowd of people. Some of them seem to be waiting for several hours without feeling distressed although they would be eager to reach home early. What holds these people back from visiting another doctor who can see them without so much waiting? It is the bond that these patient develops with their doctor, so the wait is worth the while. Based on opinions from several senior practitioners, here are some simple tips to build a great professional relationship with your patients:

Lend a patient ear! :

When a new patient comes for consultation, he is eager to explain everything about his illness from day one. He may go into a lot of unnecessary details about treatment and investigations. If the doctor has a large crowd waiting or he is in a hurry to leave for a dinner party, he may want to cut short the patient’s ramkahaani!

Please beware! The first consultation lays the groundwork for a long-term relationship.
Irrespective of the schedule of the physician, the patient should be given an unhurried hearing. Once the patient develops faith in the doctor, the further consultation with him will become easier and shorter. Listening is an important part of medical consultation, please remember.

Examine minutely:

It is an obvious fact that in most cases, dermatologists can diagnose the disorder and prescribe drugs even before the patient takes his seat in front of the doctor. Yet, allow few seconds to look at the lesion and trying to gauge what the patient feels before scribbling into the prescription pad.
Holding the magnifying glass on each lesion for some time could be a waste of time for the dermatologist but for the patient it appears as if the doctor is thinking and analyzing the lesion. Every dermatologist can treat dandruff by simply hearing the complaint. However, actually palpating the scalp and nodding to the patient that the scaling is indeed troublesome, does a lot for human relationship.

Check irrelevant reports too:

Very often patients who are not too knowledgeable about medical matters bring a big pile of blood reports, X-rays etc. In most cases, although these reports are of no clinical value to the dermatologist it would be a good idea to patiently take a look at them when the patient shows it, regardless of the rush. This would give an idea to the patient that the doctor appears to be alert to the patient’s problem.
If one was to brush it off casually without checking any report, the patient may be offended as he would have spent a lot of time and money to get these tests done. The entire exercise goes a long way in building an emotional bond with the patient.

3rd visit smile:

Everyone knows that skin disorders can take a long time to get better. Yet if the patient does not feel about 30% better by the third visit, the patient will not be inclined to visit the 4th time! While every dermatologist tries to make the patient happy, it is important that the time frame for improvement is kept in mind. As time passes, the patient’s patience wears off and with it, his faith in the doctor reduces. Once some recovery is seen on the third visit, most patients would give more time for further recovery, extending the hope-line!

Explain, explain:

For intelligent patients, elaborate on the disease and its progression in the first visit. Quite often he has searched internet and is ready with a lot of information. In recurrent diseases, indicate that there are drugs like retinoids, immune-modulators and biologics available but explain that you would reserve the tougher drugs only for difficult lesions!
Educated people can be taken into confidence while prescribing drugs so that their accurate feedback helps both parties. This also helps to seal the patient-doctor relationship, making the difficult period for the patient less stressful and also helps the dermatologist think freely without having to show magical results instantly.

Clarify prescription:

Every physician is expected to write prescriptions legibly. In India handwritten prescriptions are sometimes pathetic to read and even the chemist barely guesses the scrawl and manages to dispense drugs. Let others do what they wish, but the young dermatologist should make a good beginning with neat hand-writing. Not only should it written clearly, but also explain each medicine to the patient with the dosages etc.
Be specific about when to take the tablets/syrup with reference to meal times. Patients need to be specifically explained about when to apply creams i.e. after bath, bedtime or so many minutes before sun exposure. This small extra effort in interacting with the patient will not be easily forgotten, please note. It will also ensure fewer telephonic calls saying, “doctor, you did not tell me when to apply Perlice cream.”

Be willing to stand by:

Understand the level of intelligence of the patient. If he is not literate, do not go into technical detail, but indicate by your warmth, that you are there to help him always. Note that by providing more information that the person can handle may scare the unschooled or illiterate to think that there is something dangerous happening to him. For such people, “so what if there is no cure, I am here to help you to cope with it…” is the best line to convey your concern.

In conditions like psoriasis, relapses are depressing and it is at times like these that empathy helps. Assure him/her that we can find a way to give some relief.

Pause, ponder
All these points may seem trivial at first, but when one pauses to understand its real meaning we can put most of them to practical use. As one becomes senior in the profession, most of these suggestions will come into play automatically without any extra effort, provided they have been implemented into our work-system time and again.
Many years later, there will be a smile on your lips when a patient who had consulted you say 5-years ago returns to you with a new complaint, saying “Doc, I have got transferred to another town but when I developed this skin rash, I could only think of coming to you!”