Happy Patient Pearl

By Susan H. Weinkle, MD


“Happier patients are part of a virtuous circle of value and quality of care that links to other practice components, such as happier staff. I have found that some of the most important indicators of patient happiness relate to: patient expectations; patient satisfaction; earning and building trust; and managing bleeding and bruising, which is why I came up with this Pearl, which I gave a preview of in December 2010 at Mt. Sinai Medical Center in New York at a lecture entitled: ‘Happy Practice Pearls: Advances in Medical and Surgical Dermatology.’” –Dr. Susan Weinkle

Patient Expectations, Satisfaction and Trust

Managing expectations and increased patient satisfaction are critical to happier patients because both patient and clinician know, going into a treatment or procedure, what sort of outcome to expect in most cases, and because patient satisfaction is the ultimate goal. Examples of cases in which realistic expectations and improved patient satisfaction are particularly helpful:

  • Managing atopic dermatitis (AD), that includes patient education—possibly by a nurse practitioner—as to the chronic and relapsing nature of AD, exacerbating factors and therapeutic options (including risks, benefits and realistic expectations) (Nicol and Ersser [1]);
  • Managing pain, which should result in “happier and more productive patients” (Fechtel [2]).
  • Managing mild-to-moderate psoriasis, where patient self-management can be supported by clinicians in order to help patients “self-manage as effectively as possible to help improve their skin condition and quality of life” (Ersser SJ et al [3]).
  • Utilizing clinical photography, which is a necessity in that it helps patients visualize objective before-and-after improvements, which is especially helpful for surgical patients, in general, and Mohs patients, in particular.

Recently, a value-chain approach to healthcare has recommended implementation of Lean production in healthcare, which is “mostly used as a process improvement approach” that focuses on three main areas:

  1. defining value from the patient’s point of view;
  2. mapping value streams; and
  3. eliminating waste in an attempt to create a continuous flow of high-quality care delivery (Poksinska B [4]).

Building trust is, of course, key. Mechanic and McAlpine see patient trust as crucial to building consensus about health reform, noting: “The traditional trust patients have in physicians provides an important base on which to build” (5) (Figure 1a and 1b).

Figure 1aFigure 1a

Figure 1b

The Reina Trust and Betrayal Model (6) defines three types of transactional trust:

  1. Competence Trust, or the Trust of Capability, requires that clinicians practice humility, engage in inquiry, honor the patient’s choices and express compassion;
  2. Contractual Trust, or the Trust of Character, “requires that clinicians keep agreements, manage expectations, establish boundaries and encourage mutually serving expectations”; and
  3. Communication Trust, or the Trust of Disclosure, needs to based on respect that based on “truth telling,” especially in life-and-death matters.

Managing Bruising and Bleeding

Practical improvements related to improved recovery, reduced complications and patient anxiety include taking steps to reduce and control bruising and bleeding.

Bruising reduction strategies include, for example, identifying patients likely to bruise easily (7), utilizing single-injection techniques for mid-face rejuvenation and treating periocular lines (8, 9), rapidly treating dermal filler complications (10), using a new non-bruising cannula (Figure 2) and identifying topical (Figure 3a) and nutritional (Figure 3b) support that may help, as well.

Figure 2

Figure 3a

Figure 3b

Bleeding, especially excessive bleeding, is not only an unwanted event but something which greatly increases patient anxiety. Fortunately, new QuickClot hemostatic kaolin-based bandages (11) (Figure 4) are available that improve recovery time and prevent clinical complications.

Figure 4

In conclusion, managing patient expectations, increasing patient satisfaction, earning and building trust, and managing complications are some, but by no means all, of the ways we as dermatologists can help “happy patients” be the outcome that caregivers and care recipients achieve together.


1. Nicol NH, Ersser SJ. The role of the nurse educator in managing atopic dermatitis. Immunol Allergy Clin North Am. 2010;30(3):369-383.
2. Fechtel SG. Patient evaluation and general treatment planning. Phys Med Rehabil Clin N Am. 2006;17(2):303-314.
3. Ersser SJ, Cowdell FC, Latter SM, Healy E. Self-management experiences in adults with mild-to-moderate psoriasis: an exploratory study and implications for improved support. Br J Dermatol. 2010;163(5):1044-1049.
4. Poksinska B. The current state of Lean implementation in health care: literature review. Qual Manag Health Care. 2010;19(4):319-329.
5. Mechanic D, McAlpine DD. Sociology of health care reform: building on research and analysis to improve health care. J Health Soc Behav. 2010;51 Suppl:S147-159.
6. Rushton CH, Reina ML, Reina DS. Building trustworthy relationships with critically ill patients and families. AACN Adv Crit Care. 2007;18(1):19-30.
7. Valente MJ, Abramson N. Easy bruisability. South Med J. 2006;99(4):366-370.
8. Cattin TA. A single injection technique for midface rejuvenation. J Cosmet Derm. 2010;9(3):256-259.
9. Salti G. Botulinum toxin for periocular lines: the single-injection technique. J Cosmet Dermatol. 2004;3(3):122-125.
10. Lemperle G, Rullan PP, Gauthier-Hazan N. Avoiding and treating dermal filler complications. Plast Reconstr Surg. 2006;118(3 Suppl):92S-107S.
11. Trabattoni D, Gatto P, Bartorelli AL. A new kaolin-based hemostatic bandage use after coronary diagnostic and interventional procedures. In J Cardiol. 2010 Nov 17 (Epub ahead of print).

About the author

Susan H. Weinkle, MD

Susan H. Weinkle, M.D. is board-certified in Dermatology. She is a Fellow of the American College of Mohs Micrographic Surgery and Cutaneous Oncology and a Diplomat of the American Board of Dermatology. Dr. Weinkle graduated summa cum laude from the University of Florida in 1974 and completed her residency in Dermatology at Stanford University Medical Center in 1982, where she held the position of Chief Resident. In solo private practice since 1984, Dr. Weinkle specializes in Mohs Micrographic Surgery and Cosmetic Dermatology. She has held academic appointments at Stanford University Hospital, the University of California Irvine Medical Center, and most recently at the University of South Florida. Dr. Weinkle is affiliated with numerous professional societies. She has served on the board of directors of the American Academy of Dermatology as well as the board of the American Society of Dermatologic Surgery and was most recently elected Vice President of the ASDS. She has also served as past President of the Women’s Dermatologic Society. In 2010, she was the recipient of the prestigious Rose Hirschler Award from that group. Dr. Weinkle serves as vice chairperson of the Dermatologic Foundation and is also a board trustee. She has also been recently elected to the Board of Directors for the Florida Society of Dermatology and Dermatologic Surgery. Dr. Weinkle is a medical editor for The Journal of Dermatologic Surgery, is on the editorial board of Practical Dermatology and Cosmetic Dermatology, is a Senior Editor for the Journal of Drugs in Dermatology, and is an Editorial Advisor for DermPearls. She has published over a dozen articles on skin carcinoma, surgical techniques, and cosmetic therapies. She frequently lectures on behalf of the American Academy and other leading dermatology societies, both nationally and internationally. She has been voted one of the “Best Doctors“ for the past ten years. Dr. Weinkle is passionate about all aspects of dermatology: mentoring, scientific innovation, and building enduring relationships within the dermatology community. She lives in Bradenton, Florida, with her husband, an ophthalmologist, and their two children, ages 21 and 24.

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