When it comes to my patients, waiting still gets under my skin.  There is a rule in my office – referrals are seen within a week of getting the phone call or faxed request, sooner if it seems urgent to us or if the referring doctor asks us too.  This is part of a service oriented culture that I ingrain in my staff.  If the patient needs to be seen, we get the patient seen.  Our schedule is virtually always full and we are always booked at least a few weeks out, but time is always to be made to deal with something urgent.  In dermatology, we don’t have the same urgent issues that other doctors have, like trouble breathing, chest pain, etc.  But, there are painful, severe rashes; rapidly changing moles concerning for melanoma; infected cysts and abscesses.  Many dermatologists have become so focused on cosmetics and selling products that patients with problems like this aren’t seen in a timely fashion.

There is also another rule in my office – we don’t make patients come back for biopsies or minor procedures unless they want to.  Most of the time, suspicious lesions can and are biopsied right then and there on the same visit.  Sometimes, larger lesions, usually changing moles, may require a return visit because they are best removed using an excisional biopsy of the entire mole, but if I think the mole really truly is a melanoma, we will do those too on the same day.  Sometimes, they are rather small, only a few cm in size, but there was one that was 12 cm in size.  The best approach was an excisional biopsy of the entire mole (this is what I would demand if it were on me, my wife, or anyone in my family), so that is what we did.

The hardest part of this is sorting out the need to be seen from the desire to be seen.  The fact of the matter is that expert services are in great demand and the shortage of doctors is worsening.  This means that there will probably be some waiting.  In some parts of the country, new patients have to wait over 90 days to get an appointment with a dermatologist.  At the same time, the pace of life continues to quicken and we’d like everything to be in real-time.  This leads to a problem trying to triage patients with urgent issues from those who are impatient.  The best way I can describe it is that we don’t offer Fastpass, where you can skip to the head of the line because you want to.  You have to wait like everyone else.  However, if your skin is falling off, you get to skip.

For me and my staff, we’re always able to take care of something that is truly urgent.   It sometimes gets us in trouble because it is a great way to end up running behind, but its still the right thing to do.

If you are one of my primary care physicians who needs your patient seen today, just call.  We will squeeze them in or stay late if we have to.