Patient assessment and counseling

In dermatology we are faced with numerous skin disorders that cannot be termed as skin diseases but come under the category of cosmetic disfigurement like freckles, moles, keratosis, skin tags, syringoma, milia, and xanthelasma. Patients who approach us with the expectation of getting each and every blemish removed from their skin may be suffering from body dysmorphic disorder. Such patients need to be filtered out or counseled out using rational tactics. But, there are many others who seek removal of many unusual blemishes like every tiny flat mole and who come with unrealistic expectations that everything can be cleansed clear with modern high-tech gadgets like lasers who need to be sincerely counseled without any time constraints. They need to be made aware of the ground reality and limitations of so-called high-tech lasers with the help of photographic record as evidence.

Patient Consultation and Assessment

The most important meeting between the doctor and the patient is the consultation. Patients approach doctors for their opinions about skin problems that are troubling them physically or psychologically. The physical problems can be in the form of a callus, corn, keloid, hypertrophic scar, ingrown toenail, chronic lichenified eczema, prurigo nodularis, or wart. Psychological problems can be due to the cosmetic nature of the skin problem, such as unsightly moles, warts, xanthelasma, skin tags, keratosis, and milia.

Patients who come for removal of a cosmetic skin problem are absolutely healthy. They are very concerned about the lesion spoiling their look and hence demand removal. This patient needs proper timely consultation explaining the procedure in detail with photos and videos. The patient’s expectations need to be keenly understood.

All patients are explained the best surgical treatment whether ablative or nonablative, their possible side effects, limitations, and shortcomings with the help of case study photos from a personal library. Postoperative care should also be explained in detail.

The most important points doctors should explain to patients are that brown- or dark-skinned patients most commonly develop postoperative dyschromia or hyperpigmentation at the operated site. Fair-skinned patients commonly develop erythema at the operated site. These lesions almost always clear fully. Scarring is rare in experienced hands.

All the questions and doubts of the patient regarding his/her problem are eventually solved. Unrealistic expectations are removed from the patient’s mind.

During the consultation, the operative expenses are explained to the patient.

After all the discussion, the decision is left with the patient. If the patient is convinced, he/she will finalize an operation appointment with the receptionist.

The patient who finalizes the operation appointment is asked to do basic tests of complete blood count (hemogram), bleeding time, clotting time, blood sugar level, Elisa test for HIV, and HBV antigen test. Patients taking blood thinner medicines like aspirin are advised to stop them 2 days prior.

Patients who are posted for nonablative procedures are treated under surface anesthesia (combination of lidocaine and prilocaine in cream). The larger lesions are treated under local anesthesia of lidocaine injection, which is tested prior to operation for sensitivity.

Let us review the ideal profile of the patient who decides to get operated: