True confessions of a frustrated dermatology patient

For a little under a year, I battled severely dry, peeling skin on my hands using over-the-counter hydrocortisone creams. For a few weeks, I would think I would have it under control and then patchy spots of red, flaky, itchy dry skins would flare up on my hands.  This skin condition started over the summer when I began gardening full-time for a farm-to-table restaurant and my hands were in and out of water all day long. When spring was approaching and I was planning the new season’s garden, I realized it had been almost an entire year since this dry skin condition had started and I better get it under control before the new farming season started in earnest. It’s now been over a year and it still not under control.

The reason I wanted to share my story with dermatologists is not to have you point out all my mistakes. Rather I want to remind you that skin conditions and diseases may be commonplace to the doctors who see them every day. But to your patients, they are rare and they are personal. It’s not just a skin condition; it’s a skin condition in the middle of every day and everything else. It’s just one (annoying and sometimes painful) piece of the puzzle that is my life that I am trying to organize, do my job, make the best of, and actually enjoy!  

When I realized it had almost been a year with dry red skin, I looked up a dermatologist via my insurance company's website, searching for one near my home to make it easy to get to. I picked the name on the top of the list, called and made an appointment. The day of the appointment, I called to get the address because I couldn’t find where I had written it down. The address they gave me was in the suburbs more than an hour drive away. I didn’t have time for this, but I also didn’t want to cancel the appointment and go through the motions all over again.

I made the hour drive and arrived at the doctor’s office tired from traffic and frustrated.

The dermatologist looked at my hands, confirmed it was dry skin and in less than three minutes prescribed me a stronger cortisone cream and left room. It was not an unpleasant interaction, but it wasn’t a human interaction either. No one apologized for the wrong address in the provider directory. No one said, I’m sorry you’ve been dealing with skin condition for over a year; you made the right decision coming in to see a dermatologist.  I’m sure to the dermatologist this skin condition was quite a typical condition, but to me it personal. This skin, this itchy, red, peeling skin wasn’t just random skin, it was on my hands; the hands I use to make a living planting,growing, and washing vegetables.

What would have made this interaction better? I would recommend taking one second of your visit with a patient to imagine yourself in his or her shoes. What would you want to hear if this was your first visit to a dermatologist? What would you want to know if you had a common skin condition that was aggravated by everyday activities like washing dishes? This simple and quick practice could improve patient relationships immediately.

The next day, I brought in the Rx to the pharmacy. I was ready to get this skin condition under control. After a few minutes, the pharmacist called me back to the window and told me that my insurance company no longer covered this cream because the pharmaceutical company had increased the prices by 500%, though nothing had changed. My frustration from the previous day returned.

What do I do now? They pharmacist said she would call the doctor and ask if there was a substitute. The pharmacist told me not to worry. She would call me as soon as she had more information.

A few days later, I received a phone call from the dermatologist office. The doctor had been trying to argue with the insurance company that I needed this specific cream and had gotten them to agree that if the lower strength generic Rx didn’t work within three months, they would cover the original prescription. I appreciated this doctor going to bat for me.

This was the first time I realized that dermatologist recognized me as real person. A few simple words of understanding or encouragement would have made me realize sooner that the dermatologist was actually on my team, helping me to beat this skin condition.

I am now using the second choice Rx, which isn’t working the way it is supposed to, but I am also back in the garden. Though I am trying to wear gloves at all times, my hands are still getting wet more often then they probably should. The dry patches of red skin have crept up past my hands and are now found along my arms.

The summer season is my busiest and I sometimes forget to use the cream; I will fight the skin condition the best I can. By the time I get this skin condition under control, it may be almost two years later.

I realize that most dermatologists reading this article could tell me all the things I did wrong like that I should have gone to a dermatologist a lot sooner. But honestly, it just didn’t occur to me. I had never been to a dermatologist before.

The thing I want dermatologists to take away from my story is simple. Remember to look at each patient as a person, and through a smile, a gesture, a phrase of encouragement, communicate to your patients that you understand their frustration and pain and that you are there for them.