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Challenging patient encounters can leave both the patient and the dermatologist dissatisfied. But there are strategies to help improve communication, increase satisfaction, and encourage beneficial interactions. A live program at the summer meeting of the American Academy of Dermatology in July sought to help clinicians brush up on their skills for dealing with difficult clinical scenarios.

Kenade Shinkai, MD, FAAD, of the University of California San Francisco School of Medicine, chaired the program, one of a series of live cases in which live actors interact with attendees in a simulated clinic room. After the session, physician participants receive “rich feedback and tips” that they can take back to practice, Dr. Shinkai says in an interview with Practical Dermatology®.

What’s “Difficult”?

“There are a lot of ways patients can be difficult or challenging to a dermatologist,” Dr. Shinkai concedes, but she says many challenging interactions result from the patient being angry, the patient having too many concerns to be addressed in a single visit, or the patient asking too many questions—especially the dreaded, “Oh, by the way…” concerns raised just as the clinic visit is about to conclude.

A key learning from the session, Dr. Shinkai says, is to, “Determine what the patient really wants to accomplish that day.” It’s important to set an agenda at the start of every visit, Dr. Shinkai says. She notes that this may mean repeatedly asking the patient, “And what else?” in order to build a list at the beginning of the clinic interaction.

With a list of concerns identified, the dermatologist can work with the patient to select priorities for the current visit and set goals for future appointments.

Consider Why

Patients asking many questions can derail the clinic day, but it’s important to consider what is driving the patient’s concerns. Dr. Shinkai urges dermatologists to, “Try to understand the motivation of the patient. Usually it comes from a good place or a place of fear.”

To set the visit back on track and help reassure the patient, dermatologists can acknowledge that fear. One strategy Dr. Shinkai shares is to say to the patient, “You have a lot of questions, I wonder if you have anxiety around this new diagnosis or about this new condition or this new treatment we are about to start.” She adds that, “Offering some sort of support or empathy towards the patient can go a long way toward really helping that patient feel heard and understood. “

A Win-Win

Challenging clinical interactions can leave both parties dissatisfied. “Perhaps we walk away and we are dissatisfied or disappointed in in our ability to connect, or communicate, or counsel that patient,” Dr. Shinkai says. “It’s dissatisfying for both parties.”

Conversely, improving communication can enhance satisfaction for both parties. “Setting clinical priorities…would be very valuable at the outset of the visit and may require identifying the patient’s priorities,” she emphasizes.


Listen as Dr. Shinkai shares tips for managing challenging patient interactions.
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