My wife, Jan, and I recently returned from my annual trip to the Society of Dermatology Physician Assistant conference that was in Atlanta this year(I have heard people call Atlanta, Hotlanta, but it should have been called Coldlanta while we were there. We had to buy coats because we did not come prepared for the humid cold.) It was one of the better conferences I have been to because many of the speakers were experienced dermatologists and dermatopathologists that spoke about the latest treatments in a practical and cost effective way, instead of how to make the most money from your patients and their insurance companies. One of the more interesting things they spoke to us about was how there is little difference between a severely atypical nevus and melanoma in situ. When I explain this to patients they take it much better when I tell them they have a severe pre-cancer mole versus an early melanoma that is still in its original position(in situ). Melanoma always sounds bad. At the conference they discussed the importance of early detection and regular examinations. It is very easy to remove a pre-cancer nevus versus a melanoma that might require sentinal node biopsies and chemotherapy depending on how advanced the lesion is.
I want to shift gears a little bit and talk about more referral woes that I have to sometimes deal with. I used to get alot of referrals from the BYU-I health center. I hardly get any anymore. I think there are several reasons for this. The main one is that they are trying to save money by not referring our patients as much. They used to send me patients that needed Accutane. But everytime I talked with one of the providers up there, I felt he was trying to get information out of me regarding the ins and outs of the Ipledge program and how to prescribe the controversial medication. Now they don’t refer anymore because they are prescibing it themselves. Another issue that affects referrals is that there are more providers to refer to in town. This is where the health center is definitely not saving any money for the the LDS church or DMBA(the church’s insurance provider). Case in point, I had a student come in with a friend,( the one with the cyst on his neck that I fixed after he was sent to 2 different clinics that would not touch him and would not give him a referral to see me) who had been seen at the health center on campus and then referred to a provider in town for evaluation of his moles. He had 8 moles removed and biopsied at a cost of $250-300 per mole for the removal and biopsy. Only one of the moles turned out to be pre-cancerous. That means the church and DMBA were sent a bill for $2500 for only one mole that needed to be treated. With my experience and the use of a dermatoscope, I could have saved the patient and the church over $2000!