John McCain has good advice for Americans:
"If you ever have any slight discolouration, go to your dermatologist or doctor and get it checked," he said, while wearing a cap to protect him against the California sun.
Unfortunately, it's also a recommendation that is harder and harder to meet, because of the cosmetic, rather than medical, profit lines that dermatologists now try to fulfill:
Like airlines that offer first-class and coach sections, dermatology is fast becoming a two-tier business in which higher-paying customers often receive greater pampering. In some dermatologists’ offices, freer-spending cosmetic patients are given appointments more quickly than medical patients for whom health insurance pays fixed reimbursement fees.In other offices, cosmetic patients spend more time with a doctor. And in still others, doctors employ a special receptionist, called a cosmetic concierge, for their beauty patients.
Dr. David M. Pariser, a dermatologist in Norfolk, Va., and the president-elect of the American Academy of Dermatology, said some practices did maintain preferential policies for cosmetic patients.
“The message is that the cosmetic patient is more important than the medical patient, and that’s not a good message,” Dr. Pariser said.
At a time when dermatologists are trying to advance the idea of a national skin cancer epidemic, such a two-tier system is raising concerns that the coddling of beauty patients may divert attention from skin diseases.
A study published last year in The Journal of the American Academy of Dermatology found that dermatologists in 11 American cities and one county offered faster appointments to a person calling about Botox than for someone calling about a changing mole, a possible sign of skin cancer.
Ever try getting a "first appointment" with a dermatologist? Good luck. Try calling a dermatology practice to see if they're taking new patients - there's a pretty good chance that they're not, and if they are, the first appointment is likely to be many, many months in the future. Take a look in the phone book at their practice listings - you see terms like "cosmetic", "aesthetic", and the always happy "Botox" thrown around the yellow pages. They're turning their profession into an advanced Mary Kay industry, and I don't see any way that it can't impact those with medical needs.