What is the importance of a dermoscopy to your practice? How do you use your findings? While I own a dermatoscope, as does my PA, I rarely change my diagnosis based on dermoscopic findings and would feel uncomfortable not biopsying a nevus based on a dermoscopic evaluation of a bona fide nevus. However, dermoscopic evaluation often reassures me on seborrheic keratoses (SK) and vascular lesions, so the tool is well worth having.

Over the years I have attended numerous meetings and presentations about this technology and am pleased to see that the science is evolving. Nonetheless, I look forward to the time when the methodology is more predictable.

What kind of considerations or accommodations should physicians make for the treatment of patients who are deaf?
According to Nebraska state rules, I must make 'reasonable' accommodations for a deaf patient. This may mean many different things for different patients. For example, if you have an unaccompanied child who is deaf or one who has non-signing parents or guardians, it may be entirely reasonable to hire an interpreter. On the other hand, if the patient is able to read and write, I frequently have communicated via an interpreter.

Whatever the case, make sure that you know the cost and hours to be charged for the interpreter should you hire one. We routinely ask this question and many times are shocked that the rates for the interpreter can be higher than our office charges that day! Despite this, if you are legally compelled to provide an interpreter, you must do so. Consider calling your state health department for any particular rules. Additionally, if you practice near a hospital, consider checking to see if a staffer there who is able to sign is willing to assist for the patient.

Lastly, remember the importance of not turning away this deaf patient or refusing to make a sincere attempt to assist him or her. A recent case in New Jersey resulted in a $400,000 verdict against a rheumatologist who refused to provide this type of care, which puts a chilling cost on not knowing or following the rules.

Send your questions to tpigeon@bmctoday.com. Dr. Schlessinger will answer your query or find an expert who can.