"I never went back to that dermatologist; he just wanted to sell me creams.” I've heard this more than once. I have also heard similar remarks about other healthcare providers that sell things in their offices. My mother was having lens replacement surgery and her ophthalmologist recommended a lens that was not covered by Medicare, with an out-of-pocket cost of thousands of dollars. His aggressive approach made her very uncomfortable. These patients and others like them now view their healthcare providers as salesmen and won't go back. In addition, they will probably tell their friends about their bad experience. It's the worst kind of negative advertising.

In reality, many of these healthcare providers were simply trying to tell patients about a product that they really believed would benefit them. These providers talked about their products in the wrong way at the wrong time, ultimately ruining their relationship with the very patients they were trying to help. These common mistakes are totally avoidable.

The profit made from dispensing skin care products is very small compared to the revenue obtained from medical and cosmetic services. Nonetheless, there is high demand for products among interested patients, and the revenue from product sales can be significant. While a practitioner may examine the risk/benefit ratio of dispensing and decide not to do it, it should be noted that there is a virtually risk-free method of presenting skin care products to your patients in a professional manner. When a program is properly implemented, a practice can enhance care by educating patients about proper skin care, improving outcomes, and providing access to higher quality products than are available over the counter, all while adding a new revenue stream to the practice. The steps below focus on all of these benefits without patients ever feeling like they are being “sold.”

Why Dispense

Increasingly, dermatology clinicians recognize that proper skin care is an essential part of many treatment plans. Working in offices that dispensed skin care products, I learned that in-office dispensing does have real benefits for patients. It leads to better outcomes, it's convenient for patients, and many patients prefer the security of buying a product from their dermatologist. Although it's hard always to measure their benefits scientifically, doctor-only dispensed product lines tend to be of superior quality. They often have unique formulations and can contain higher levels of certain ingredients than are available over the counter. Patient feedback is generally excellent and the products keep patients coming back.

Once a practice chooses to dispense skin care products, it has to reprogram the way staff think about “selling.” In fact, they must reject the notion of selling. America has such a high-pressure, sales-oriented culture that when we sell skin care products, there is a powerful kind of behavioral gravity that pulls us toward the mannerisms and techniques of salesmen. This happens largely on an unconscious level. The cultural programming is so ingrained, I still find myself fighting it to this day.

Because we have no frame of reference for selling things other than retail/high-pressure sales, one has to reprogram oneself and one's staff. Dispensing products is a team effort. Repeat this mantra daily and post it on the wall of the nurses' station: “We do not ‘sell' anything! We educate patients about skin care products.” Your staff may be a little puzzled at first, but they intuitively understand that the last thing a patient wants when they go to their doctor's office is to feel like they are being “sold.” Follow up by saying, “We are not salesmen. We are not the cosmetics counter at the department store. We are trusted skin care experts here to help people.”

Rethink Product Presentation

Next, implement guidelines and techniques to present— not “sell”—products in a low-pressure, educational way to patients. The patient should never feel that they are being “sold.” Your goal as a healthcare provider is to educate and assist patients about using the right type of skin care products just as you would any other medical issue or prescription medicine. Obviously, this assumes that you and your staff are well educated about skin care products yourselves. If clinicians and staff are not educated on products, they should think twice about dispensing them.

If you do a lot of cosmetic procedures, consider bundling the cost of the recommended in-office aftercare products into the cost of the procedure package. You can present the cost of the procedure like this, “The price is $1,000, which includes $100 of high-quality aftercare products to speed your recovery and all follow-up visits.” Patients are very happy leaving the office with all the products they need and knowing exactly how to use them. They may even feel they got the product for free! This is good medicine, good service, and good marketing.

Three Steps for Success

Step 1: Assess the patient's skin type and talk about the type of product the patient should be using first. The goal of a medical professional is not to get people to buy products but to make sure they are using the right type of product for their condition. Talk about skin care products in the same manner you do prescription drugs, by discussing active ingredients and properties. Discuss the pathophysiology of the patient's condition and how the right type of skin care product can help. Often times, the first step is discussing the patient's skin type (oily, dry, sensitive, etc). If you jump right into touting the advantages of your product, or even mention that you sell products, people will immediately think, “He's selling me something.” Patients will stop listening, become uncomfortable and possibly visibly upset. If this happens, make an immediate course correction and figure out what you did wrong. Now is the wrong time to recommend your product or even to let the patient know you sell products. This doesn't happen until step 3.

Step 2: Assess the patients' interest in the product. If there is no interest, drop the matter and move on. People feel they are being “sold” when they are approached about a product they do not want or don't see the value of. Even if it's the perfect product for them and will improve their condition, if the patient isn't receptive, don't force the issue. In most cases, a product will not be crucial to their medical outcome and can be discussed during future visits.

You can assess a patient's interest by asking probing questions. For example, let's say you have a patient with rosacea. You ask the patient their skin type and he replies, “It is sensitive and dry.” You explain that rosacea is a form of sensitive skin and tell him that he should be using a gentle soap-free cleanser and an intensive, hypoallergenic moisturizer. Then you ask, “What cleansers and moisturizers are you currently using?” An example of a high-interest response would be: “I'm using product X, but I'm not sure it's doing me any good. What would you recommend?” This is a green light; the person is not happy with the products and is interested in your recommendation, which is a sign of trust.

A low-interest response might be: “I use product line X and have been for years. I really love them.” At this point, unless there is a compelling reason to go in depth about skin care, such as the stated product is probably exacerbating the skin condition, just reply, “That's great; those are good products.”

Men often times don't understand the value of good skin care products and may give you a response like this: “I'm using something my wife gave me. It seems to work fine.” For this patient, reinforce the type of product you want him to use without specifically recommending your product line, provide written information, and move on.

Step 3: Provide the patient with written information and recommend your product at the very end. Healthcare providers educate and empower people by providing the information they need to make their own decisions, in their own time. Salesmen pressure you to buy their product now. They do not want to empower people with too much information in fearing they'll use that information to shop around elsewhere. Giving patients user-friendly written information is vital when discussing products. The information should include price and clearly spell out the key ingredients and properties of the product. The best way to present product information is to design patient education sheets for specific conditions with recommended products included. This gives the patient integrated information on all the parts of a successful treatment program: prescription drugs, in-office treatments, and skin care products. Doing this reinforces the point that skin care products are an important part of the treatment program. You can even organize the skin care products by skin type. Besides increasing compliance, taking the time to do this establishes you as an expert with a plan. It is a powerful tool.

Hand the person the written information, circle your product recommendations, and say, “I'm recommending some products that I get a lot of good feedback on. The most important thing is that you get the right type of product. All the information about the products' properties and key ingredients are clearly listed on this sheet. If you want to take the guesswork out of purchasing the right type of product, you can purchase these products at the front desk. Do you have any questions?”

It is crucial that you do not talk about your product or that you even recommend products until the very end. This prevents the patient from shutting down because they think you are trying to sell them something and missing all the vital information about using the right type of skin care products. Also avoid saying, “Would you like to purchase that now?” In sales, that is called “asking for the sale.” Salesmen do that, not healthcare providers. End by saying, “Do you have any questions?” The patient has been educated, you have offered them the convenience of getting the right type of high-quality skin care products in the office, and have empowered them with the information they need to purchase the right type of product where and when they choose. You will absolutely be viewed as a helpful healthcare professional and not a salesman.

The Three As

You might be thinking that this seems like a lot of steps and will take a lot of time. In fact, these are the exact same steps that you use everyday when discussing diagnosis and treatment. I call them the three A's: Assess, Advise, and Assist. With practice, they become automatic.

• Assess: Diagnose the patient and find out their skin type
• Advise: Recommend the right type of skin care product
• Assist: Provide written information and offer the patient the convenience and security of purchasing the right type of product in your office.

Keep in mind you don't have to have an in-depth discussion on skin care at the first visit. The majority of times, I introduce skin care during the first visit and gauge the patient's interest. Unless it is very high or unless a certain product is crucial to improve the patient's condition, I save that discussion for the follow-up visit. I provide written only and say a few words about the importance of using the right type of products. On the first visit, I focus on obtaining a thorough history, discussing prescription medications, and doing basic patient education.

Can you imagine diagnosing and treating a patient while skipping any of the above A's? It doesn't work in medicine and it doesn't work when educating patients about skin care products either.

Display Basics

A good product display does the educating for you. It should have the functionality to sell a product all by itself. It should include brochures and testers. In addition, it should have a small card listing prices and a brief product description. Ask your product vendor for help. Put the display in an area that is visible but not the focus of the waiting room.There is a fine line between displays that look commercial and those that look informational. When in doubt, opt for a low-key informational display.

Be an Educator not a Salesman

Being viewed as a salesman is the kiss of death for any healthcare provider. If you don't want to be viewed as a salesman, then don't act like one! Salespeople pressure customers to buy things they may not need and do not provide information to empower them to make their own decisions. They stress buying their products before buying the right type of product. Healthcare providers educate patients, provide information, and stress the right type of product first and their product second. They never “ask for the sale.” By changing the mindset of yourself and your staff and following the steps above, you can help patients get better outcomes and add a new revenue stream to your practice. Most importantly, you will remain a trusted healthcare provider in the eyes of your patients.

Steven Leon, MS, PA-C works at Advanced Dermatology in Palmdale, CA.