Evaluation
Evaluation
A successful consult—one that converts an interested consumer into a patient—rests on the rapport between the physician and patient. Before entering the examination room, physician and staff should put cell phones on silent to minimize distraction. If the physician knows she will be interrupted for an expected phone call, explain, and apologize to the patient in advance. Even if there is only one physician in the office, the physician should introduce herself to the patient on entering. Older studies suggested patients prefer to be called by their last name, but this may have changed, along with the transformation of “doctor” and “patient” to “health care provider,” and “consumer,” respectively.12 A safe standard is to refer to the patient by last name until he or she says otherwise. Alternatively, match the way the patient refers to the physician—if the patient uses a first name, the physician certainly can. Taking the time to sit down during the consultation rather than standing has been shown to have a positive effect on the doctorpatient relationship.13
The single most important factor in establishing a good relationship with the patient is to listen. Despite, the inclination to get the answers via rapid fire questions, speak slowly, use open-ended questions, and let the patient speak. If time is of the essence, use a variant of responsive listening—repeating back to the patient what he or she expressed to the nurse or assistant in the preliminary interview as in “My nurse Tina and I reviewed your conversation. My understanding is that you are most concerned about your jowls.” This defines the physician’s assistants as part of the team and let the patient know that the team has heard their concerns.14 After reviewing the history, hand the patient a hand mirror and ask for him or her to point out major concerns. This keeps the focus on what the concern is, rather than on one specific treatment option about which that the patient may have heard.10,15
After reviewing the pertinent history and establishing the patient’s concerns, it is time for the physician evaluation. For most noninvasive cosmetic dermatology procedures, it is best to examine the patient sitting upright or standing in order to see the effect of gravity. Look at the patient from multiple angles and gently palpate, pull, and pinch tissue as needed and ask the patient to make expressions. Include additional physician examination as appropriate for the specific procedures being considered. Document pertinent negatives such as the absence of thyromegaly or umbilical hernia during a consult for submental or abdominal fat reduction, respectively.