How To Manage Patient Expectations

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Dr. Malkin says it’s “important to convey to patients that onychomycosis (as shown above) is not a consequence of aging. It’s an infection.” (Photo courtesy of Aditya Gupta, MD, PhD)
Here one can see severe onychomycosis with onycholysis and subungual debris. According to Dr. Malkin, when people are informed that onychomycosis can become worse without treatment, it is a key motivating factor for them to see a doctor. (Photo courtesy o
“I believe spending extra time with the patient will facilitate a better outcome.”   
— Dr. Cervantes
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Dr. Cervantes: Obviously, there is a lot of data and clinical experience in dealing with onychomycosis, but I think the key is educating the patient. You can provide the best medications, whether they are topicals or oral drugs, to the patient but if he or she doesn’t know the medication works or doesn’t get involved with the treatment, the treatment will fail.
I definitely believe spending an extra few minutes with the patient will facilitate a better outcome. Patients must understand that onychomycosis is an infection so this is a legitimate threat. We must emphasize the risks and complications of not treating this disease. Perhaps showing some of the available data to the patient will kind of stimulate his or her participation in the treatment of this condition.

We have control of the environment and we can affect the lifestyle of the patient but we have no control of the host. Again we have to educate patients about the condition and let them know there is a high chance of recurrence.
We have been talking about these expectations, the recurrence and the potential side effects of oral antifungal medications. It’s also important to keep in mind that the drugs available now have a very small percentage of cure. For example, according to the package insert for terbinafine, the medication offers a 38 percent complete cure rate.
We must emphasize to the patient that treatment can be a long process. It’s not like a fever. They can’t just take antibiotics or some Tylenol and it will go away. This is a long process and they need to understand why it takes so long. If the patient participates in the treatment and is aware of the recurrence rate, it will facilitate treatment and everybody will be happy.

Presenting Onychomycosis: How To Convince Patients
About Treatment And Compliance
Dr. Mozena: Once we have established that onychomycosis is an infection, we essentially need to educate the patient of the social implications in that it may spread among themselves and to others.
We also need to educate our patients about the treatment plan, whether it’s topical or oral medication, and the need for debridement of the nail. We need to educate our patients to the long-term expectations, the need for constant treatment and then I think we have convinced the patients.
Dr. Malkin: Patient education starts with educating yourself as the physician. You have to buy into what you are trying to sell to the patient. If you believe a hallux valgus repair is in a patient’s best interest, you prepare a balanced presentation but the end result is that the patient has an understanding that your recommended treatment is in his or her best interest, and it may be surgery.

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