The telltale plastic bag of flakes
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, April 1, 2020
For many of us, that baggie is the start of a really bad day, because while we all recognize delusions of parasitosis, few of us are completely comfortable treating it. If you are one of those whose fear of the disorder is bad enough to make you consider a completely different career, we have a separate article in this month’s Dermatology World (see “Side gig”). The rest of you will hopefully enjoy contributing writer Jan Bowers’s insightful look at the disorder in the second article in our series on psychocutaneous disorders.
Establishing the diagnosis often takes some finesse, as well as time with the patient, even if the diagnosis is suspected right off the bat, and our experts emphasize the importance of ruling out both underlying psychiatric disorders, such as schizophrenia, and substance abuse. Commonly used (and abused) medications including amphetamines, meth-amphetamine, and even cannabinoids can cause symptoms that mimic delusions of parasitosis. As the use of these drugs increases, so may the frequency of patients who present with related skin disorders ranging from skin picking to frank delusions. And then, of course, we need to treat the disorder, which can be challenging for those of us who are uncomfortable prescribing antipsychotic drugs. In an ideal world, we would manage these patients in tandem with our psychiatry colleagues. Unfortunately, in many cases this cannot, or will not, happen and the management falls to us. We can provide a true service to these often-troubled patients by learning more about these medications and developing at least a basic comfort level prescribing them. Who knows, you might actually get a good online review from your patient…but that’s another article this month!
Living in the days of Yelp has both good and bad aspects. Who knew that the online review process would spread to involve professional services such as ours? Whether you love them (said no one I know) or hate them enough that you refuse to read them (my general approach), online reviews are out there, they appear to be here to stay, and you can almost bet that your patients are reading them. DW contributing writer Ruth Carol offers useful strategies for managing bad online reviews. Spoiler alert: Ignoring a bad review may not be the best strategy, but you also need to be careful in how you respond so as to not inadvertently make the situation worse. Also, patient confidentiality must always be guarded. Several of our colleagues offer great advice for interacting with online patient reviews and may help you see how these can be used to benefit your practice.
We’re only a few months into 2020, but it’s not too early to be thinking about how you will fulfill your reporting requirements for MIPS. The performance thresholds to avoid a penalty (or potentially receive an incentive) took a huge leap from 2019 and if you do not yet have an EHR, it will be impossible to qualify for the maximum incentive this year. Participation in DataDerm™ can make reporting easier, so if you aren’t yet hooked up, this might be a great year to do so! I guarantee you won’t regret it.
