Dermatology Of Northern Colorado, P.C.

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*** *** ** *** November 11, 2014 Revdex.com C County Rd Ste 100 Fort Collins CO 80528 ID:*** To Whom It May Concern: This letter is in response to a costumer complaint (ID# ***) about a recent skin exam at Dermatology of Northern ColoradoIt saddens me to know that the patient was upset with her recent visit as I truly did try my best to address all of her concernsI think the main reason the patient is upset is because her expectations were not metHowever, the expectations of what the patient wanted to accomplish in a single office visit were not reasonableThis is not her faultMany patients do not understand that when seeing a specialist, the amount of time scheduled for appointments are generally 10-minutes in lengthThis is because most dermatology issues (acne, skin screenings, rashes, warts) can be discussed and treated in minutesIn this case, the patient had multiple concernsI did try to solve as many of her concerns as possible, but she was disappointed when I told her she'd have to return to have benign lesions removed. The patient stated that she waited in the waiting room for minutesIt is very abthat I run this far behindI truly value my patient's time and try my best to stay on timeI feel it is rude to make patients wait, especially when our appointment times are relatively shortI did investigate what took place with this particular patientHer appointment time was 3:50pmShe came early (per our request for new patients) to fill out our paperworkOur medical record system (very accurate) shows that she was brought back at 4:05pmOn this particular afternoon, it looks like I was running minutes behinddo apologize for my tardiness, but sometimes unforeseen events occur. I would also like to address her remarks about the skin exam she receivedAgain, I believe this is a case of a patient not knowing what to expect from a skin examI will admit some blame in thisIn general, a "mole check" means that a dermatology professional will examine ALL areas of the person's skinI personally have found melanomas in a patient's scalp, on a breast, on a penis and on the bottom of a foot (along with many other trunk and extremity melanomas)In all of these cases, the patient was not aware that they even had a mole in those areasI would guess that 70% of the melanomas we find in a dermatology office are lesions that the patient was unaware of. Therefore, my goal is to be as thorough as possible so as to not miss a potentially life-threatening lesionWhen I performed her skin check, I combed through her scalp looking for hiding moles, I examined her skin normally covered by underwear, and I even looked between her toes to make sure there were no suspicious lesionsIn general, the brief embarrassment a patient may feel when having a skin check (or a PAP smear or a mammogram) is outweighed by the need to make sure she does not have a hiding cancer. However, in this case, I feel awful that the patient was not comfortable during the exam. Had she mentioned that she felt uncomfortable with me viewing certain areas, I would have limited my skin check to the areas of her comfortI understand that she may have been too nervous to say anything, but I can't know her feelings unless she communicates them. The patient's complaint that I "did not tell her what I was doing" is inaccurateWhen I first entered the exam room with this patient, I shook her hand, introduced myself, and stated that I was going to perform her (requested) skin checkI told her that I will look everywhere and that I will start in the scalp and work my way down toward her feetTo be fair, many patients are nervous when they are undressed and do not always remember doctor visits accurately. I am glad this patient has brought this issue to my attentionI have learned that when a patient requests a skin cancer screening or a mole check, they may not always know what that entailsI will aim to make sure that new patients, especially, are informed of the skin check process. Another complaint this patient had was that she had multiple moles she was worried about, and I told her they looked finePatients often will come in worried about a new or changing mole and sometimes I am able to reassure them that the lesion in question is benignNormally, patients are happy when I tell them that their moles do not look worrisomeI am unsure why this patient was upset with me for saying as muchAs the patient states in her letter, she had a mole on her knee that she was worried about and thought it was getting bigger and darkerI told her it did not look concerning but agreed to biopsy it since she was worriedThe pathology report confirmed it was benignIn hindsight, I think this patient was just very worried and I think she expected me to be worried as wellI did not live up to her expectations when I tried to be reassuring. After completing the patients skin exam we discussed a rash she had on her faceI discussed the name of her rash, the possible causes, and that it can be treated with either oral or topical antibioticsI discussed oral antibiotics are more effective, quicker acting, but also have side effectsI discussed the possible side effects of the medication in questionThe patient was nervous about taking oral medications but also wanted her rash to resolve as quickly as possibleIn the end, I prescribed both the oral and topical medications with the plan that she would try topical first and if she was not happy with the results, then she could pick up the oral medication. We next discussed a rash that she had been getting occasionally on her forearmWe discussed possible causes, and I gave her samples of a cream to help treat the rash. The patient then stated that she was concerned about some moles on her faceThey were not dangerous but cosmetically irritating to the patientI told her that she would have to return at another time if she wanted them removedI also discussed the likely scar that would be created by removing the molesI emphasized that there is no way to remove a mole without leaving at least a little scar and that she should consider that before having anything benign removed on her faceI've had the experience in the past where a patient thought she'd prefer a small scar to her mole, but after having the mole removed, the patient had found the scar more disconcerting than the mole had beenHad these been worrisome moles, I would have made time to remove and biopsy themHowever, in this case, I thought it was in the patient's best interest to take some time and consider her options. I hope you can see that I tried my best to address as many of the patients concerns as possibleI am sorry that I did not meet her expectations but I can assure you that she was given thorough medical care. Should you have any additional questions, please do not hesitate to contact me. Sincerely, *** ***, PA-C, MMS

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