Prioritizing emergency patients

                Dr. Lisa Garner 

By Lisa Garner, MD, FAAD

A male patient, age 55, phones your office to schedule an appointment after detecting a suspicious mole on his chest. He has first been seen by his primary care physician, who believes this is a lesion that is serious and has referred him to you. What do you do?

  1. Reschedule a patient with a less urgent concern in order to examine the patient’s mole as soon as possible.
  2. Make arrangements to come into the office early to see the patient before your scheduled appointments or add him at the end of your day.
  3. Tell the patient that your schedule is full for the next several weeks. He can either wait until you’re free or schedule a time to see your PA at an earlier date.

If you answered “3”, it’s time to evaluate how you prioritize patients.

Limited access to dermatologists is one of the key negative perceptions about our specialty by both patients and other physicians. It’s true that the availability of dermatological care varies widely from region to region. We know that care is plentiful in some locations, but other locations have long wait times for a variety of reasons. Unfortunately, there are some areas of the country that are critically underserved. One way to combat this negative impression is for dermatologists to be more aware of these access issues. 

The Academy’s Ad Hoc Task Force on Perception has been brainstorming strategies that very busy dermatology practices may consider to enable the dermatologist to accept more emergent and urgent referrals from other physicians. However, one approach the task force sees as problematic is that some practices put emergency referral appointments on the schedules of the nurse practitioner or physician assistant without oversight or evaluation by the dermatologist. When you have a physician to physician emergency referral, it can appear to show indifference if the patient is not actually evaluated by the dermatologist. Being able to see one “emergency” patient each day sends a truly positive message to patients and our fellow physicians. If another physician is concerned enough about a patient’s dermatologic problem to call and request an immediate visit, I want to respect that if at all possible. 

Host a screening this May!

We’ve got big plans for Skin Cancer Awareness Month this May. It’s the one month out of the entire year that national attention is focused on skin cancer. This creates the perfect opportunity for us to educate the public on a much higher scale about the importance of early detection and how to SPOT™ skin cancer.

That’s where you come in. By hosting a free skin cancer screening in your community, we can collectively influence positive behavior change to improve public health, and, at the same time, clearly demonstrate how dermatologists offer a unique and significant value to the public.

Last year 500 members hosted a screening. This year we want to increase that to 2,000. Can we count on you? Learn more and order free screening materials on AAD.org.

Focusing on patient prioritization and access is particularly important as we prepare for the Academy’s SPOT Skin Cancer™ campaign. This highly successful broad-based public health initiative, which was launched in 2012, draws visibility to the Academy’s skin cancer programs and also brands dermatologists and the specialty in connection with the disease. This year’s SPOT™ campaign, which will rollout on Melanoma Monday on May 5, will focus on detection. Through this effort, we’ll urge millions of people to perform self-exams and see a physician if they see a suspicious mole. 

There is emerging evidence that self and physician skin examinations may result in reduced melanoma thickness at the time of diagnosis and lead to improved survival. The Academy is spreading the message that when caught early, skin cancer is highly treatable — and one way for patients to catch it early is to check their skin regularly and see a board-certified dermatologist if they notice a changing, itching, or bleeding skin lesion. 

Strategies to improve access 

If patients that respond to the SPOT™ campaign cannot access a dermatologist, then we have provided only a small part the community service this program is designed to provide. We have not made it to the "TREAT" portion of the SPOT™ campaign. So, I urge members to assess their current scheduling process and wait times. If you have long wait times, please consider taking steps now that may improve access for patients. 

Here are some suggestions you may want to consider that other dermatologists have used:

  • Add special appointment slots to your daily schedule:
  • “Emergency” appointments that are meant to be filled on the day of the appointment only, and are reserved for patients who must be seen the same day. Generally, one is in the later morning and one is in the afternoon; if they’re not filled by 9 a.m., they’re released for general scheduling.
  • “Consult” appointments are given to patients whose physician offices call directly for appointments. There is usually one per day on the schedule; they are released to general scheduling if they’re not filled a week before the appointment date.
  • “Hold” appointments are for the use of the front desk receptionists who are scheduling patients as they leave. There are usually three or four on the schedules of the busiest providers; they allow the provider to see a patient in two to three weeks when the regular schedule is four to six weeks out without overbooking your schedule
  • Refer the patient to a dermatologist colleague who might have a shorter wait time.
  • If you practice in the appropriate setting, you may be able to utilize teledermatology to facilitate triaging patients who are more urgent.

Dr. Garner is a board-certified dermatologist in private practice in Garland, Texas. She is immediate past vice president of the AAD and is chair of the Ad Hoc Task Force on Perceptions of Dermatology. She is also a member of the Ad Hoc Task Force on Office-Based Surgery and Ad Hoc Task Force on Teledermatology.

 

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