Skin Care Ain't What it Used To be

Like that episode of Seinfeld, you’ve often noticed how when you go to an airport to catch a flight, the treatment you get as a coach passenger is acceptable most of the time, but the civilities are slowly eroding. When you call the airline as a coach passenger, you get an automated voicemail maze; the first-class people get a real person to talk to right away; they get a soft-lit luxurious waiting lounge at the airport with free drinks and peanuts; you’re lucky if you get a metal chair,sticky with someone else’s popcorn, and fluorescent lighting shining in your face. If you ever noticed recently, at any clinic run by a dermatologist, skin care patients usually get coach treatment; the dermatologists act like the customers who wait for their appointments over at the luxury annex are the real patients.

If you haven’t guessed who those lucky “real patients” are, who get the kid-glove treatment, they are the ones who come in for cosmetic dermatology – not for the suppurating psoriasis and acne like the rest of us. The doctors are pretty matter-of-fact about the whole deal. Legitimate skincare issues get paid for by health insurance – a fixed sum that cuts the dermatologist’s margin down as far as it will go. Dermatologist skin care for cosmetic purposes, Botox, skin plumping and so on, get paid for at the market rate – they make a lot more money on this. And of course, everyone pays more attention to the cash cow.

The second-rate treatment that genuine skin care patients get, goes all the way. They find it harder to get an appointment, there may or may not be a proper receptionist for pre-treatment counseling, they never get to spend as much time with the doctor, and it becomes impossible to re-schedule an appointment. Serious patients who call with potentially worrisome problems, like a stubborn and discolored patch on the skin that might come from a sexually transmitted disease or cancer, still have to wait in line behind someone who comes in, say, for dandruff; all while, they watch the vanity patients grandly welcomed to the other section. The dermatologist skin care department treats the serious patient as second class, and they don’t even care if you know it.

Nothing can match the indignity of not even getting to see a doctor sometimes, though; in many cities across the country, the serious patients only get to see the physician’s extender, a special nurse; and the doctor is usually busy attending the real customers, probably with a gold-plated Botox syringe in one hand. But wait! Perhaps that isn’t the biggest indignity after all. When patients do get the actual dermatologist,skin care, curiously, seems to be the last thing on his mind, often. Patients often complain that the real problem on their minds is quickly dismissed as “no big deal”, so that the doctor can launch into a sales pitch for some beauty cream, lotion or other as soon as possible. People do complain of how doctors can sometimes dismiss serious cancerous symptoms in favor of a sales pitch.

A clinic for medical skin care, will often have to work three times as longer for half the pay; and that pay comes after the doctor argues with the health insurance company over what treatments he is allowed to give the patient, and after waiting for them to reimburse him – sometimes, a month. The vanity dermatologist on the other hand, gets paid twice that, does not have to go through the hassle of arguing with anyone, and gets paid on the day. It is not just the fancy private practice that does this either. University teaching hospitals are getting into it too, as patients complain. Well, one day, those same fancy vanity doctors’ clients will visit a dermatologist skin care in mind. And then they will get to see how the other half lives – the lower half.

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