Sanity Check: Aren’t all skin things cosmetic?
Submitted by Dr. Gwenn Is In
When I read this article by the NYT titled “The Price of Beauty: As Doctors Cater to Looks, Skin Patients Wait”, I was stunned on many levels. The article described a “typical” dermatologists office that almost seemed so surreal it could have been a scene from a movie or a TV show such as “NipTuck”: two waiting rooms, two types of procedure rooms, for two types of patients.
There was a luxurious waiting room with a very comfy and soothing procedure room for the “cosmetic” patients, such as the botox patients in one area of the office. On the other side of the hall, so to speak, was the more clinical waiting room with comfy furniture but nothing special and a treatment room that was, well, clinical, for patients coming in for “noncosmetic” issues like acne or psoriasis.
According to one dermatologist interviewed for the story, Dr. Richey from California:
“Cosmetic patients have a much more private environment than general medical patients because they expect that….We are a little bit more sensitive to their needs.”
I stopped at this point scratching my head. Aren’t all “skin things” cosmetic? Just look at a patient with an intense and disfiguring case of acne or a widespread case of psoriasis or eczema, are you going to tell me, Dr. Rickey, these patients do not have a “cosmetic” problem? I would argue those patients, the “skin patients” as he called them, require even more TLC than the cosmetic patients. For some, I can only imagine the silent pain of looking in the mirror wondering when they will look like themselves again.
Beauty may be in they eye of the beholder but what Dr. Richey is missing is that all skin is cosmetic and all patients walking into his office are after the same goal: to look more beautiful to themselves and the outside world. Sure, he won’t get rich for “skin things”, but he’ll have a much more satisfied patient than the ones coming in for botox seeking the fountain of youth.
The system has gotten so out of hand that people with true skin conditions are having more and more trouble getting into see a dermatologist. I used to think it was because there were just not enough dermatologists so not that many appointments…then I read this in the NYT article:
“In some dermatologists’ offices, freer-spending cosmetic patients are given appointments more quickly than medical patients for whom health insurance pays fixed reimbursement fees….In other offices, cosmetic patients spend more time with a doctor. And in still others, doctors employ a special receptionist, called a cosmetic concierge, for their beauty patients.”
This is truly troubling on so many levels! But, thankfully, the tides are changing.
Not all dermatologists agree with this out of control system such as Dr. David Pariser, the president-elect of the American Academy of Dermatology who told the NYT:
“The message is that the cosmetic patient is more important than the medical patient, and that’s not a good message.”
There seems to be a tide changing to delineating better the type of practice that a dermatologist has to help patients find a “medical” dermatologist vs. a more cosmetically focused one. As the NYT article points out, one way you can find a dermatologist more medically oriented is to go to a group based in a large hospital or medical center. Those groups may practice cosmetic dermatology, too, but will have dedicated medical dermatologist as well.
Remember, all “skin things” are cosmetic. If you have a skin problem, make sure you find a doctor who truly believes that. Otherwise, get a second opinion.
BTW, for kids, there are pediatric dermatologists. You can find them at most children’s hospitals.
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