Savvy selection weeds out problem patients

"If things don't work out, for whatever reason," he says, "patients should have the psychological strength and ego to manage that," in conjunction with their doctors.

Conversely, he advises avoiding patients who:

"The primary sign of a good patient is that one has a sense of comfort and rapport with the patient. Conversely, the primary sign of the patient who may not be a good candidate is someone with whom one feels a sense of discomfort or a disconnect," Dr. Adamson says.

A sense that there's something missing in the patient's psyche or that the patient just doesn't seem to "get it" after repeated explanations also are tipoffs, he says.

Starting a practice

Such criteria assume added importance in the beginning phases of a practice, Dr. Adamson notes. In this scenario, he says, "Sometimes individuals encourage themselves to take on patients who may not be ideal."

However, he says that if one thinks about it, "One builds a practice from a few patients, and they expand in an inverse pyramid over time. And, generally speaking, nice people - patients who are well-grounded - tend to have nice friends. Those are the people whom they'll refer" after having a positive experience.

"At the end of the day," he says, "there are very few perfect patients. But most of them will fit into a profile on the Gaussian (bell) curve that one is fairly satisfied with."

Dr. Adamson adds that, in his experience, approximately one in five potential patients fails to make the cut, for reasons that can include unrealistic expectations and psychological issues.

In patient selection, he says, "One must always put the patient's interests first." For example, Dr. Adamson says physicians should not hesitate to suggest a different procedure than what the patient initially requests if it will provide better results, or to encourage a patient not to proceed if he or she isn't a good candidate.

"We have an obligation, if we feel that a patient is not a good candidate for a procedure, to tell them why, and encourage them not to do it, even with another doctor," rather than simply turning them down without educating them regarding what's in their best interest, Dr. Adamson says.

Whether one is a dermatologist or surgeon, he adds, "One needs to know one's own capabilities, and accept one's limitations."

Satisfied patients