Having a high quality doctor’s visit takes effort on my part and on yours. Here are 10 tips to get the most out of your next dermatology visit with me or any other dermatologist.

1. Write down all the questions you have and things you want to discuss with me. Be sure to list any spots you’d like me to check or any moles that have changed. Have a loved one lightly mark spots on your skin they are concerned about.

2. Know your family history: Has anyone in your family had skin cancer? What type? Patients often have no idea if their parents have had melanoma. It matters. If possible, ask before seeing me.

3. Know your history well: Have you had skin cancer? What type? If you have had melanoma, then bring the detailed information about your cancer. Your prognosis depends on how serious the melanoma was, that is its stage, 1-4. You need to know how it was treated, if it had spread, and how deep it was. The answers to these questions determines the risk of your melanoma returning.

4. If you have a rash, there are a few things I’ll need to know: Have you changed any of your medications? Soaps? Moisturizers? Cosmetics? Do you have a history of eczema? Asthma? Hayfever? Does anyone in your family have a skin disease? Take a picture of your rash at its worst with your phone; the rash might be improved by the time you see me.

5. If you are seeing me for acne, come prepared. Keep a journal of when your acne is worse. Is it around your period? When you are stressed? In summer or winter? What products or cosmetics are you using? What treatments have you tried? Have you had dryness or burning with previous treatments?

6. If you are seeing me for hair loss, then collect your hairs that fall out and count how many you lose in one day. It’s normal to lose 100-150 hairs per day. Make a list of other symptoms or health problems that you think might be related to your hair loss.

7. Always be honest with me. I’ll never judge you even if you are an avid tanner or a picker. I’m here to help, and I can only help if I know the whole story.

8. Have you read something online that you’d like to discuss with me? Print it and bring it. Sometimes patients will tell me they saw something about their disease on the web; without knowing the source, I cannot say if the information is valid or helpful.

9. Am I leaving too soon? Stop me. My time with you is yours. If you see me heading for the door, then tell me that you still have things you’d like to cover. If we are out of time, then ask me if you can set up a follow-up appointment to continue the visit.

10. Don’t leave empty handed — I’m not talking about the freebie hand lotion or drug samples. For every doctor’s visit, you should leave with printed or written instructions about what we discussed and what you should do next. Patients who receive hand-outs from their doctor are more likely to have positive outcomes.

Have you had an excellent or not-so-excellent dermatology visit you’d like to share? Do you have any tips for us?

Photo: Maggie Osterberg

Related posts:

1. 7 Tips to Get the Most Out of Your Next Doctor’s Visit Patient satisfaction has more to do with communication between...
2. Dermatology Chair Warns of Unproven Cosmetic Devices At a recent dermatology meeting Dr. Christopher Zachary, a...
3. Melanoma Skin Cancer Website Here is an excellent melanoma skin cancer website for...

Related posts brought to you by Yet Another Related Posts Plugin.

HealthCamp is coming to San Diego, September 7th, 2010 at theTown and Country Resort and Convention Center. It will be in coordination with the 2nd International mHealth Networking Conference.

HealthCamp is a collaborative experience that focuses on social media, interactive health technology and mobile health (mHealth) for better health care.

HealthCamp is a user-organized “un–conference” that brings together consumers, health providers, payors, health industry experts and technology professionals for a one (1) day session to exchange ideas informally and openly. Participants themselves provide the content. The crowd determines the break-out sessions which are posted on a grid and people attend any of the sessions they desire throughout the day. Anyone can present or host a session.

Past healthcamps have been in Boston, Philadephia, Washington, DC, Nashville, San Leandro (San Francisco Bay area), Maryland and the UK. For an overview of healthcamp, click here.

Please consider joining me and many other leaders in health care social media this inaugural event in San Diego.

Related posts:

1. Why Twitter Is Bad For Your Health The paradox of Health 2.0 is that along with...
2. The Plague Hits San Diego The plague has hit San Diego. No, I don’t...

Related posts brought to you by Yet Another Related Posts Plugin.

The paradox of Health 2.0 is that along with unlimited access to medical information comes unlimited exposure to medical misinformation.

Social networks like Twitter and Facebook are replete with marketers in sheep’s clothing, pseudo-doctors (I hate to be a stickler, but a doctor should be a doctor and not just be a cool moniker like Queen is to Latifa), and friends who happen to be dumb.

When you combine these characters, finding truth is difficult in a sea of social media untruths. In this way, Twitter is bad for your health. Using social media sites to help with your medical problem means you’re getting lots of medical misinformation.

A study published in the American Journal of Infection Control proved this point. The authors looked at tweets and retweets about using antibiotics to treat a cold. They discovered that inaccurate or misinformed tweets were rampant and exposed 850,000 or more people to bad advice or wrong information about antibiotics.

I decided to do my own quick study. I searched eczema on Twitter; from the first 100 tweets here’s what I found:

• A whopping 84 were spam.
• There were sneaky spammers like a real-looking person who tweeted “Grandson 2 yrs horrible eczema tried all specialist not any better steroids no help?” and linked to a scary-bad-English site where you can buy drugs online without a prescription.
• A real person who advised that eczema was caused by drinking coffee. (He must know something I don’t).
• Three “natural doctors” (Queens?) with books and videos that promise to “CURE YOUR ECZEMA NOW!” (They obviously went to better medical schools than I, because I never learned the cure for eczema).
• Patients giving medical advice to other patients. One link to a discussion went: “My 1 year old daughter has terrible keratosis on her arms and legs. Help?!” Discussion response: “Your daughter has keratosis pilaris. Use Eucerin Intensive Repair Lotion.” This is bad for several reasons. It’s inappropriate for anyone to give medical advice online, even a physician. I would never make such a diagnosis without seeing the child. I doubt keratosis pilaris is the correct diagnosis in a one-year-old. Lastly, Eucerin Lotion has alpha-hydroxy acid which is inappropriate to put on an infant (it might burn her skin).
• Several links to a “Toothless Fish” that eats skin and will cure your eczema. Seriously.
• An at-home LED light device that apparently we doctors don’t want you to know about. It treats your eczema AND acne AND wrinkles! Whew, I’ve been keeping that in for so long, it feels good to tell you. Now you know about the secret LED, and a burden has been lifted off my shoulders.
• A twitterer with a potty mouth that I’m not gonna repeat here.

How do you know that the information you’re getting is accurate? Can you trust your friends? Social media and Health 2.0 are here to stay and have the potential to benefit patients and physicians. So how should you navigate to avoid bad advice?

• Always question the source of the information. Both well meaning people and spammers can harm you — if it sounds too good to be true, it’s probably not true.
• Always see your physician for diagnoses and medial advice. Use social media only to supplement your knowledge or to connect with other patients or health providers.
• Always remember, you really don’t know who is posting information online — I could be a dog, after all, and you’d never know it.

Photo: Caricaturas (from flickr) and Peter Steiner, The New Yorker (from wikipedia).

Related posts:

1. Disclaimer The information on this blog is for educational purposes...
2. HealthCamp is Coming to San Diego! HealthCamp is coming to San Diego, September 7th, 2010...
3. Dermatology Chair Warns of Unproven Cosmetic Devices At a recent dermatology meeting Dr. Christopher Zachary, a...
4. Dr. YouTube Will See You Now YouTube, with over 80 million videos, has become a...
5. About Dr. Benabio Jeffrey Benabio, MD, FAAD Dr. Benabio grew up in...

Related posts brought to you by Yet Another Related Posts Plugin.

Is the milk you drink rBST-free? Is your physician board certified?

Many people take the time to buy hormone free milk, but they don’t make an effort to choose a physician who is board certified. That’s a shame.

Asking a friend or family member might be a good way to choose a hairdresser, but it is not a good way to choose a physician. Medicine is difficult. The same way that you want the pilot of your next flight to be maintaining his or her skills and knowledge of flying, you also want your physician to maintain his or her skills in medicine. The truth is, you are much more likely to die from your doctor’s mistake than from a pilot’s mistake.

Being board certified is no guarantee that your physician is good (or nice!), but it does assure you that your physician is committed to continuing education and is learning advances in medicine. It also assures you that your physician has completed the necessary training and passed a certification exam for the field of medicine he or she is practicing. Having a license means only that they completed the minimal requirement to practice medicine. Maintaining active board certification means that your physician has undergone yearly continuing education and has passed a re-certification exam every few years.

Certainly there is more to being a good physician than completing residency and passing written and oral examinations. But studies show that high exam scores do correlate with practicing better medicine.

There are 24 board specialties. You can check to see if your physician is board certified by going to the American Board of Medical Specialties site at ABMS.org, registering, and putting in your physician’s name. It is a free and confidential service. You can have a nice glass of rBST-free milk in the meantime.

Post written by Dr. Jeffrey Benabio, Copyright The Derm Blog 2009.

Photo: Ingrid Taylar (flickr)

Related posts:

1. How to Get Into Dermatology: A Life Hack Dermatologists love to cite that the most difficult specialty...

Related posts brought to you by Yet Another Related Posts Plugin.

How many patients never fill the prescription for a medication given to them?

A. 2%

B. 5%

C. 13%

D. 22%

E. 30%

F. 68%

Believe it or not, its E. 30%.

A study published in the Jounal of the Americal Academy of Dermatology found that nearly 1 in every 3 people never fills the prescription medication that was written for them!

There are many reasons why. The most important is that there was a breakdown of trust between the physican and the patient. If a patient does not feel that his or her doctor’s diagnosis or treatment plan is helpful, then he or she will be unlikely to fill the prescription. Also, if a patient does not understand the diagnosis or treatment, then it’s unlikely they will be compliant with taking their medications.

Even if the patient trusts the doctor and understands the treatment plan, prescriptions are expensive! If you have a limited budget and the prescription for a rash costs $75, you might have second thoughts — do you really need to treat it?

Most of the chronic skin conditions I see in clinic could be treated if people used their prescription as directed. However, like eating a good diet, excercising, and getting 8 hours of sleep, taking prescriptions is difficult.

• Physicians have to take the time to properly diagnose you and to ensure that you understand your condition and how to treat it.
• Your physicain should ask questions at the end of the appointment to ensure that you understand. Getting a hand-out with written information about your condition, about your medication, and instructions on how to use your medication is also important.
• Physicians should also consider cost; sometimes choosing a generic medication is much better than the  name-brand because the patient can’t afford the new medication. Using a generic medication is in most instances just as effective as a name-brand and is certainly more effective than not using a medication at all.
• Having patients return to clinic within a week or two of a new diagnosis is also a great way to reinforce medication use and to help encourage patients to continue their therapy.

• As patients, it is your job to help yourself. Keep a written record of when you have used your medications. Be honest of course.
• Set your medications aside in a weekly pill box so that you are sure to take your all your pills everyday.
• Make note of how many days you did not take your pills in the last week.
• Most of the time when a medication seems to stop working, it is because you have stopped using it. Seeing your physician for a new prescription is often more likely to waste time and money than it is to make a difference in your condition.

Related posts:

1. By the Numbers: Generic vs Brand Name Drugs Total number of prescriptions I wrote in the last...
2. The Benabio Guaranteed* 2008 Acne Cure (*If You Use It, That Is) Do you use Proactiv®? Many of my acne patients...
3. How Does Proactiv Work? Many of my patients ask me about Proactiv. You...

Related posts brought to you by Yet Another Related Posts Plugin.

Are you taking your medications? Probably not.

In a recent dermatology study, a mere 50% of adults and 30% of children were still using their medications 8 weeks after they were prescribed.

But what if I sent you a text to remind you? Would you be more likely to take your meds or use your creams?

Taking medications or applying creams takes effort and discipline. Unless you form a new habit and apply your medication or take your pills at the same time everyday, it is unlikely you will persist. It is similar to exercising — if you exercise at different times and different days, then it is much more difficult to stay exercising than if you developed a habit and did it as part of your daily routine.

There might be a new way to help encourage people to get into a habit of taking their medication everyday: text them.

A recent study presented at a Society for Investigative Dermatology meeting showed that texting patients actually improves compliance (that is, the likelihood that they will take their medication). In the study, 70 cell phone users were randomized to receive a text message reminder to apply sunscreen everyday or to not receive the text reminder.

At the end of 6 weeks those who received the text reminder were more likely to apply their sunscreen as compared to those who did not receive the text. In the text group, people used the sunscreen 56% of the time while in the control group they used it only 30% of the time.

The researchers cleverly attached the weather forecast to the text message to make the message more useful and to encourage people to open the message and read it. The act of opening and reading the message everyday helped them get into the habit of applying the sunscreen everyday, improving their compliance.

In my practice more and more patients use email to communicate with me. Texting might be another way to communicate with patients to help them be more compliant with their therapy.

You can’t text me, but you can twit me if you like.

Like this blog? Grab The Derm Feed

Photo: Sintex

Related posts:

1. Why Prescription Drugs Don’t Work How many patients never fill the prescription for a...
2. Blood Pressure Meds Lower Skin Cancer Risk Taking blood pressure medications might do more than just...
3. The Benabio Guaranteed* 2008 Acne Cure (*If You Use It, That Is) Do you use Proactiv®? Many of my acne patients...

Related posts brought to you by Yet Another Related Posts Plugin.

YouTube, with over 80 million videos, has become a popular resource for health information. But is the information provided helpful?

This video has had over 81,000 hits. In his 5 minute lecture, the expert describes:

1. The need to take Cod liver oil with vitamin A to prevent a vitamin D overdose.

2. How the real danger in tanning beds is not the ultraviolet light, but rather an electromagnetic field from magnets.

He goes on to describe how this “radiation” or “rays” or “field” (he cannot decide) causes “significant disruption in your energy field … and increases your risk of cancer.” He advises you to find a tanning beds that uses electronic rather than magnetic sources, because electronic tanning beds are “very beneficial” to your health.

OK.

First, in order to overdose on vitamin D, a healthy adult would have to take about 50 vitamin D tablets (50,000 IU) a day for months. There is no relationship between vitamin A intake and vitamin D absorption.

Second, there is no evidence that magnetic fields are dangerous. MRIs generate magnetic fields 45,000x greater than the earth’s magnetic field. (A new MRI can generate 9.4 T, which would be over 280,000x stronger than the earths magnetic field!) There is no evidence that even these superpowerful magnetic fields increase your risk for any type of cancer.

It is, however, well documented that ultraviolet light is carcinogenic. Tanning beds cause premature aging, discoloration of your skin, and increase your risk for developing melanoma.

Physicians need to take better advantage of online media to educate people and consumers need to develop critical thinking skills. Just because an “expert” gives a lecture on YouTube, does not mean the information is helpful (although I did find it entertaining).

I need to get a video camera ….

Related posts:

1. Why Tanning Is An Unsafe Way To Get Vitamin D I made this video while at the Lance Armstrong...
2. Is the Tanning Industry the New Big Tobacco? The $5 billion tanning industry has taken a bold...
3. UV Light for Acrylic Nails Might Cause Skin Cancer “It’s like a mini tanning bed for your fingers....

Related posts brought to you by Yet Another Related Posts Plugin.

Patient satisfaction has more to do with communication between doctor and patient than with the skill of the physician. With that in mind, here are seven tips to help you get the most out of your next trip to the doctor’s office:

1. Make a list. It has been said that doctors don’t like when patients come in with lists — it’s not true. A list is the best way to ensure all your needs are met. However, anticipate how much time each problem will take. If you have a list of 15 things, and we only have a 15 minute appointment, that means we have to cover each item in a minute or less. If you know you have a lot to discuss, then ask if you can book a longer appointment.
2. Start with the most difficult issues first. Too often patients wait to the end of the appointment to bring up difficult or embarrassing issues. Research shows that patients who bring up difficult issues at the start of an appointment are more likely to be satisfied with the visit and to adhere to their doctor’s recommendations.
3. Know your personal history. You will likely change insurances and doctors several times in your life, so it is critical that you have a copy of your medical history. For example, I saw a patient yesterday who claimed to have a history of melanoma — in fact he had a basal cell carcinoma – there is a huge difference. Giving the wrong history can affect your treatment, prognosis, and your ability to get insurance in the future.
4. Know your family history. It is important in determining your risk of disease and can sometimes help diagnose a condition.
5. Bring your medications. A typical exchange in my office: Me: “I am going to prescribe triamcinolone cream.” Patient: “Oh, I am using that already, Doc.” Me: “Well, let’s try fluocinonide cream then.” Patient: “No wait, flu-o-cino-something, yeah, that’s what I’m using now.” Me: “Are you sure it is not fluocinolone cream?” Patient: “Well, I don’t know. It’s definitely a cream though.” Two words: Not helpful.
6. Ask questions. It’s important that you understand what was said and what you need to do. Ask for instructions in writing before you leave. If you realize you missed something after then visit, then call or email your doctor.
7. Do your homework. It’s always helpful when you know about your condition. There are some great resources on the web and taking the time to learn will make you a better patient. Be cautious about self-diagnosing though (especially from pictures on the web!). It’s OK to ask questions of your physician, but it is rude to challenge them. Physicians spend tens of thousands of hours studying their field; be respectful of that — Google only makes it look easy. If you think your physician is wrong, then get a second opinion.

At your dermatologist’s office, don’t be afraid to mark spots on you that you want checked. Also, it can be helpful if you have pictures. Rashes change over time, so if you want me to see what it looked like at its worst, then take a few pictures. I actually had a patient who shot a short film of her skin problem — for the record, video is overkill (unless you bring Junior Mints, then it’s OK).

Post written by Jeffrey Benabio, MD. You might also like:

How to Avoid Razor Bumps

How to Stop a Shaving Nick From Bleeding

Are You Over-Scrubbing Your Face?

Skincare Myths: Plucking Hair Makes it Grow Back Thicker

Like this blog? Grab The Derm Feed

Related posts:

1. 10 Tips to Get The Most From Your Dermatology Visit Having a high quality doctor’s visit takes effort on...
2. How Safe Are Procedures in a Doctor’s Office? 5 Tips to Stay Safe The (un)safety of cosmetic procedures is getting more media...
3. Why Prescription Drugs Don’t Work How many patients never fill the prescription for a...

Related posts brought to you by Yet Another Related Posts Plugin.

When I informed a patient earlier this week that I would be happy to surgically remove his skin cancer, I was surprised by his response. “I didn’t know you were a surgeon,” he said. He was under the misunderstanding that dermatologists did not perform surgery.

Most dermatologists do not perform surgery in a hospital operating room, but we do perform a lot of cutaneous surgery.

How much? According to data from Medicare and Medicaid:

• Dermatologists performed more excisions of malignant skin lesions than any other specialty.
• Dermatologists performed 454,012 excisions of malignant lesions in 2004 (the latest data available). This was four times more than the next closest specialty, Plastic Surgery, which performed 112,412 excisions of malignant lesions.
• Dermatologists also performed more benign and malignant excisions, complex skin repairs, flaps, dermabrasions, laser treatments, chemical peels, and Mohs procedures of any specialty.

Certainly surgeons in Plastic Surgery, General Surgery, Oculoplastics, and Ear, Nose and Throat Surgery are trained in skin procedures and have expertise and training in areas outside of dermatology.

But do dermatologists do surgery? Yep. We sure do.

Related posts:

1. Dermatologists Perform More Cosmetic Procedures Than Other Specialties Need Botox? See your podiatrist today! Or your dentist!...
2. Over Half of Dermatologists Provide Cosmetic Services According to a recent study as reported in Skin...
3. Florida Teen Dies After Cosmetic Surgery 18-year-old Stephanie Kublea died after cosmetic breast surgery. It...

Related posts brought to you by Yet Another Related Posts Plugin.

The (un)safety of cosmetic procedures is getting more media attention this year especially after the death of Kayane West’s mother, Donda West, following cosmetic surgery. So are procedures in a doctor’s office safe? Here are five tips you’ll need before going under the knife.

Many thousands of procedures are done each year in doctor’s offices. The vast majority go smoothly and without complication. However, all procedures, including cosmetic, medical, or even Botox, have some risk. A study published in this month’s Dermatology Surgery summarized findings from seven years of data in Florida. In Florida all incidents of death, serious injury, or hospital transfer from a doctor’s office must be reported to a central agency. (Why don’t all states have this? They should.)

The authors found that in 7 years of collecting that there were 31 deaths and 143 procedure-related complications.

Of the 31 deaths, 18 were in patients undergoing a cosmetic procedure. The majority of the deaths and the complications that required transfer to a hospital were associated with liposuction, abdominoplasty (tummy tucks), or bundled procedures — when multiple procedures such as liposuction, abdominoplasty, or breast surgery are done together.

As a result of Donda West’s death, a new law has been introduced in California that would require all patients undergoing cosmetic surgery to be medically cleared by a licensed physician, such as their primary care doctor, before undergoing surgery. Although well intentioned, it is not likely that laws such as this would do much to protect patients. In Florida, for example, 78% of the deaths were in ASA Class I patients, which means they were healthy patients with no medical problems prior to the procedure. Having a doctor’s approval before the surgery, therefore, would not likely have made any difference.

Office-based surgeries are generally safe, but many of these procedures, especially those requiring general anesthesia have a real risk that must be carefully considered. Here are five tips to help you stay safe when undergoing any significant surgical or cosmetic procedure in a physician’s office:

1. Ask if your physician is board certified and if the office has surgery accreditation (this is voluntary in most places, but a good idea, especially if the procedure you’re having is significant).
2. Ask your physician how many times he or she has done this procedure and what complications he or she has had.
3. Tell your physician all the medications you are taking, including over the counter medications and diet supplements.
4. Tell your physician any risk factors you might have for blood clots including family history, smoking, and oral contraceptives.
5. Before you undergo any procedure, be sure that you completely understand what will be done and what the risks are. Anesthesia and blood clots are two of the more serious risks of surgery, and you should understand them completely before agreeing to the procedure.

Photo credit: Cyrill Vallee, Flickr.com

You might also like:

Is the Tanning Industry the New Big Tobacco?

How to Make a Chocolate Facial

Vitamin C and Skin Care

Skincare Myths: Plucking Hair Makes it Grow Back Thicker

Like this blog? Grab The Derm Feed

Related posts:

1. Dermatologists Perform More Cosmetic Procedures Than Other Specialties Need Botox? See your podiatrist today! Or your dentist!...
2. 7 Tips to Get the Most Out of Your Next Doctor’s Visit Patient satisfaction has more to do with communication between...
3. Florida Teen Dies After Cosmetic Surgery 18-year-old Stephanie Kublea died after cosmetic breast surgery. It...

Related posts brought to you by Yet Another Related Posts Plugin.