Page 9 - FACETHETICS

SLICE OF A COSMETIC
DERMATOLOGIST'S LIFE
Dr. Rajetha Damisetty, MD
CONSULTANT DERMATOLOGIST
A cosmetic dermatologist has the opportunity of interacting
with patients with fascinating personalities in the course of a
day’s work. Here is a tongue-in-cheek perspective of a few of the
myriad of scenarios at work, inspired by Robert Bramson’s
treatise on “Coping with difficult people”, where he describes
the hostile-aggressives, the complainers, the silent and
unresponsive type, the super
The hostile-aggressive bulldozer
Fifty two year old Ms. X is fifteen minutes late for her appointment and
arrives in a mood that is fouler than usual. She says “We are not so good,
doc” when I ask her how she is doing. Her use of the royal plural never fails
to amuse me. And then she starts, loudly “Doc, why is it so difficult to find
parking at your clinic? It took me ten minutes to park my car! And please
fire your assistant. She was rude to me yesterday when she made the
confirmation call. ” In my best soothing tone, I say “She told me that you
wanted to come at 9.30 and that she could accommodate you in the 10.30
slot. We’ll make sure the valet parking driver is available when you come
next”. She: “Doc, look at these pics. I look older than all my friends. My
eyes look so tired”.
Me: “You think so?! You look so fit. And we’ll have to work on
your eyelids. A ml of filler would take care of that”
She: “I look fit because I slog it out. And these women who don’t lift a finger
look younger! And look at these comedone-thingies, doc!”
Me: “Have you been taking testosterone supplements again?”
She: “I had to. My libido is down in the dumps. You don’t expect me to live
with that.”
Me: Trying not to roll my eyes and start off on the effects of
testosterone supplementation in women, “Let’s see how to
handle your comedones”. Her friend nodded vigorously and hmm-ed
and ha-ed.
The Silent, Unresponsiveclam
Ms. Y, thirty five years of age, came for a consult. Her friend, who
accompanied her, said that she wanted to get rid of the dark circles around
her eyes. Handing her a mirror, I explain, using my well-rehearsed script
that is devoid of jargon, how her loss of eyelid fat and the ensuing ‘shadow
effect’, her thickened eyelid skin caused by insulin resistance, the fine lines
due to loss of collagen were contributing to her ‘dark circles’.
Whenever I look for affirmation at the client, I found her staring at my right
ear blankly. Thankfully, Without getting discouraged by the client's
silence, I ploughed on, penning down a nice treatment plan starting with
assessment of percentage body fat, waist circumference and visceral fat, a
HOMA IR estimation and ending with some TCA peels and Hyaluronic
acid injections. I made sure I told her what percentage improvement she
can expect and that maintenance with a good skin care regimen and
healthy lifestyle is required, along with repeating the filler injection after a mollycoddling, the ones who adhere to our treatment,
year. Ms. Y stared thoughtfully at the treatment plan I made. I fidgeted in
my chair, resisting the temptation to break the stifling silence. After what
seemed like ages, she finally made eye contact with me and said “Can you
permanently remove my dark circles with the injection?”
The super-agreeable fawning nosy client
My manager brought in Ms. Z, a client who has been keeping tabs on
me for years. She breezed in wearing a bright smile and exclaimed,
“Doc, your skin is glowing! What have you done of late? And you have
lost weight!” I willed my professional smile to stay frozen while I told
her “I have actually gained some weight.” In her chirpy voice, she
started “I saw your WhatsApp profile pic. You look amazing! Nobody
would believe that you have a son who is that old. Was that a vacation
pic?” This time, I gave her a genuine smile and said “my son is only
eleven. He is tall for his age. Thanks!” I decided to put her out of her
misery. She wanted my approval, her tense shoulders at conflict with
the affable expression on her face. I told her “Love your bag! Looks
great on your toned arms.” She beamed at me and at the world, as we
walked to the procedure room.
The classic dysmorphophobic
19 year old Mr. S was brought by his mother for a hair consult. He had
been distressed by his hair loss and has missed a month of college. His
maternal uncles were bald before the age of thirty, while his father
started having thinning hair in his late forties. At a glance, I saw that he
had a nice head of lustrous hair. He had minimal temporal recession
and dermascopy of the scalp showed significant hair diameter
diversity, which I demonstrated to both the patient and his mother. I
reassured them that the temporal recession was a secondary sexual
character of males and that we can halt the progression of his hair
thinning, possibly regrow some of the lost hair too.
S said “All my friends say I am going to go bald. I feel like everyone
stares at my head”. His mother pitched in “every time he sees a strand
of hair anywhere in the house, he becomes withdrawn. He locks
himself up in room all day”. I repeat all the things I said about the
excellent medications we have. They remained skeptical. I asked the
patient to step out for a minute and tell his mother - “he is certainly
having early male pattern hair loss. But his emotional distress can't be
explained by the hair loss. He needs counseling, possibly medication
too for the emotional component”.
The mother looked like she'd been hit by a boulder. I braced myself,
wondering whether to say the big word “psychiatrist' or try and soften
the blow by using the silly term “mind-health doctor”
And the day continued…..
Thankfully, for every difficult patient/client we meet, we see
at least 10 normal ones, the ones who don't need too much
whose progress we rejoice in. But without the difficult ones,
life would be less fascinating, our emotional intelligence
less challenged. May we continue to live in interesting times S
E
and lead satisfying lives! V
E
N