Patients refusing to undress for skin exam

[Dermatology66]

Sometimes I come across patients that appear in my clinic either 1) for a total body skin examination 2) follow up for a rash or biopsy after provided treatment plan and refuse to undress and state "everything has cleared" or they describe their current situation "it's a little better but still itchy". Sometimes the patients become upset because I require them to undress even though they may think the symptoms have cleared or are improving. I am having a hard time explaining to them that they are at the dermatologist for a specific reason - for an expert medical examination! Also, how do you document if patient requested a focused assessment or refused for me to assess the site?

Any recommendations from the derm world?

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[asmallchild]

Sometimes I come across patients that appear in my clinic either 1) for a total body skin examination 2) follow up for a rash or biopsy after provided treatment plan and refuse to undress and state "everything has cleared" or they describe their current situation "it's a little better but still itchy". Sometimes the patients become upset because I require them to undress even though they may think the symptoms have cleared or are improving. I am having a hard time explaining to them that they are at the dermatologist for a specific reason - for an expert medical examination! Also, how do you document if patient requested a focused assessment or refused for me to assess the site?

Any recommendations from the derm world?

Are you in dermatology or family medicine/internal medicine?

I typically have my medical assistants offer a gown to the patient, encourage them to disrobe down to their undergarments (underwear/bra), and won't enter the room until the patient has done so. This is obviously more commonly accepted in a derm practice so you may have difficulty doing this if you are in another field.

If the patient does not wish to disrobe, then I'll document pt declines full body skin exam and will document what I was able to see on partial skin exam.

If I enter the room and find the patient does need a full body skin exam to be thorough (multiple skin cancers found on partial exam and now I want to see the whole body, a rash that extends diffusely across the body, etc), I'll once again hand them the gown, ask them to disrobe down to their undergarments, and quickly leave the room before they can voice any opposition. Therefore, it's understood I won't be returning until the patient has changed into a gown.

 

[MOHS_01]

Y'all need to be less paternalistic. Just tell them (while walking out the door) that the melanoma hiding on their back, leg, etc, may well be the preventable death they were hoping to avoid by coming to a dermatologist -- and then make them reschedule for a full skin.

Document you tried, they refused. Next patient.

 

[doctalaughs]

Agree w above. My MA automatically tells them i recommend a full exam. If i come in and they are still dressed I'm not wasting 5 more minutes arguing and waiting for them to change. I examine the areas requested and document "further exam offered and declined". If they really should have one (ie prior melanomas or multiple nmsc) I will personally mention it on the way out (ie "You know, you really need a full skin exam. Let my staff schedule that for you in a month or so").