Mohs Surgery for Skin Cancer Explained by Dermatologist Dr. Patrick Killian, M.D.

Posted on January 23, 2012 by Dr. Mark

Mohs Micrographic Surgery is the most successful procedure for removing nonmelanoma skin cancers.  The goal of Mohs surgery is to completely remove the skin cancer while keeping as much normal skin tissue intact.

Dr. Patrick Killian, Mohs Surgeon

Patrick Killian, M.D., Dermatologist and Mohs Surgeon

Patrick Killian, M.D., Mohs Cancer Surgeon at Trillium Creek Dermatology & Surgery Center describes the benefits of Mohs surgery for the treatment of skin cancer, and what to expect from the procedure.

Skin cancer is the most common from of human cancer. There are three major types of skin cancer; basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. Basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer. They are referred to as “nonmelanoma skin cancer”  to differentiate them from melanoma, the most serious form of cancer that can metastasize (or spread) throughout our body.

According to Dr. Killian, “with Mohs surgery, 100% of the specimen is examined, which explains why Mohs surgery results in much higher cure rates than other forms of surgery. This differs from a standard surgical excision when the pathologist slices the specimen vertically, like a loaf of bread. Using this technique, the pathologist is only sampling the margins of the tissue, so only 1%  of the specimen is being examined.”

Processing the skin sample during Mohs Surgery takes about 1 to 1.5 hours. Once the sample is processed, it is examined under the microscope to check multiple sections, making sure all of the cancerous cells have been removed. If cancerous cells are still present, the Mohs surgeon must go back and remove more tissue until the margins are clear upon examination. Once the margins are clear, the wound is sutured and dressed and you are given complete home care instructions. The average time spent at the clinic by a Mohs patient is 2-6 hours, depending on the case.

According to Dr. Killian, “because Mohs surgery removes the smallest amount of tissue possible, the size of your scar is minimized. Also, more importantly, all cancerous cells have been removed.”

About Dr. Patrick Killian

After obtaining his Doctorate from Ohio State University College of Medicine in 1999, Dr. Killian quickly joined the American Academy of Dermatology, the Ohio Dermatological Association and the Central Ohio Dermatological Society.

Dr. Killian served as a resident in the Division of Dermatology at Ohio State University and completed a fellowship in Mohs Micrographic Surgery in 2004 at the Skin Cancer Center in Cincinnati, Ohio.

A noted authority on Mohs Surgery, Dr. Killian has authored several publications and lectures to colleagues on a variety of dermatology topics. He has received many honors including Salutatorian at University of Notre Dame where he received his undergraduate degree, and honors standing throughout medical school.

Dr. Killian is a Cleveland area dermatologist in private practice in Medina, Ohio.

Call the Mohs Skin Cancer Center at 330.721.9990 to schedule an appointment with Dr. Killian or another dermatologist at Trillium Creek Dermatology and Skin Surgery Center.

The Mohs Skin Cancer Center is located at 5783 Wooster Pike, Medina, Ohio 44256.

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Latisse® for Beautiful Eyelashes – Reviewed by Skin Care Expert Dr. Jeffrey Dover

Posted on January 19, 2012 by Dr. Mark

Latisse® is a prescription-only medication applied to the eyelashes once-a-day to create longer and thicker eyelashes. It’s use to enhance beauty and create longer more beautiful lashes is reviewed by skin care expert and Boston-area dermatologist, Dr. Jeffrey S. Dover

Dr. Jeffrey Dover, Dermatologists

Jeffrey S. Dover, Boston Area Dermatologist

“We have had excellent results with Latisse® thus far”, says Dr. Dover. “Bimatoprost (the active ingredient of Latisse®) was first used to treat glaucoma as an eye drop medication and a beneficial side effects that was noted was increased eyelash length and thickness.”

“Painted on the upper eyelash in a very large study, it increased the length of eyelashes an average of 30% and doubled their thickness. Most of the individuals in the study were very pleased with the outcome.”

“Patients have been uniformly very pleased,” said Dr. Dover. “Their lashes get longer and thicker and become much more appealing looking. Only approved for use to help to thicken eyebrows we have treated a few patients who have thin eyebrows and they so far been quite please with the results.”

When treating eyelashes, Latisse® is applied to the upper eyelashes only. It should not be applied directly into the eye. It takes about 8 weeks to notice results and it can take up to sixteen weeks to see the full effect of the medication. When you stop using Latisse the eyelashes eventually go back to the way they were prior to treatment.

” I think it is a wonderful new addition to our options for so many women in America whose eyelashes are not quite as thick as they would like,” said Dr. Jeffrey Dover.

About Dr. Jeffrey Dover

Dr. Dover received his dermatology training at the University of Toronto followed by research fellowships at St. John’s Hospital for Diseases of the Skin at the University of London in London, England, and a two-year photomedicine fellowship at the Beth Israel Hospital and the Massachusetts General Hospital of Harvard Medical School. Dr. Dover is a former Associate Professor of Dermatology at Harvard Medical School, was Chief of Dermatology at the New England Deaconess Hospital for over ten years and also Associate Chairman of Dermatology at Beth Israel Deaconess Medical Center. He is Associate Clinical Professor of Dermatology, at Yale University School of Medicine, and Adjunct Professor of Medicine (Dermatology) at Dartmouth Medical School. A Boston dermatologist, and director of SkinCare Physicians, Dr. Dover’s research interests are lasers in medicine, cosmetic surgery and medical education.

Dr. Dover is the author of over 350 scientific publications. He has co-authored and edited over 30 textbooks. Many of these books are on cutaneous laser surgery and cosmetic surgery. He is founding editor of Journal Watch for Dermatology, produced by the publishers of the New England Journal of Medicine.

Dr. Dover is immediate past president of the American Society of Dermatologic Surgery, and vice president of the American Society of Lasers in Medicine and Surgery. He is past president of the New England Dermatological Society and organizes and directs numerous medical conferences, including the annual Controversies in Cutaneous Laser and Cosmetic Surgery Symposium along with Dr. Arndt.

Dr. Dover, creator of Skin Effects, the skin care line available at CVS Pharmacy nationwide and author of the “Youth Equation – Take 10 years off your face”

Dr. Dover is in private practice in the Boston area at Skin Care Physicians of Chestnut Hill. To make an appointment with Dr. Jeffrey Dover or one of his colleagues call (617) 731-1600, or visit the practice Website.

Skin Care Physicians of Chestnut Hill is located at 1244 Boylston Street (Route 9) Chestnut Hill, Massachusetts 02467. Fax: (617) 731-1601

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Dysport Treatment for Wrinkles Reviewed by Todd Minars, M.D.,

Posted on January 17, 2012 by Dr. Mark

Dysport™ (abobotulinumtoxin A) was approved by the FDA in 2009 for the treatment of moderate to severe frown lines between the eyebrows (glabellar lines). Like Botox™, Dysport™ is an injectable form of botulinum toxin type A and provides physicians with another treatment option for wrinkles and other signs of aging.

Todd Minars, M.D.

Todd Minars, M.D., Miami Area Dermatologist

Todd Minars, M.D., dermatologist in private practice at Minars Dermatology in Hollywood, Florida, provides his expert opinion regarding Dysport™ for the treatment of wrinkles.

” I consider it to be pretty much equivalent to Botox“, said Dr. Minars. “I tell patients it is “Coke vs. Pepsi”, or two different brands of basically the same thing.  There are a few differences worth mentioning.”

“Dysport also has a reputation of diffusing a little bit further beyond the area of injection than Botox. I think that this is a true, though minimal, difference. This can be an advantage or a disadvantage and the injector must take it into account when treating patients. This extra diffusion seems to be an advantage when treating hyperhidrosis patients (those with excessive sweating0. These patients have less breakthrough sweating with Dysport than with Botox.”

“The most important question is which lasts longer? And as far as I can tell, they both last the same amount of time.”

Dysport works by blocking the signal from the nerve to the muscles, resulting in a reduction of muscle activity and temporarily preventing contraction of the muscles that cause wrinkles.

Injection Sites for Dysport

Dysport Injection Signs for Wrinkles

Just 1 injection into each of the 5 points above the eyebrows reduces the appearance of frown lines.

The untreated facial muscles still contract normally, allowing you to freely show facial expressions, such as smiling.

You should wait at least 90 days between Dysport treatments. The safety of Dysport has been studied in up to 12 repeated treatments. Clinical studies demonstrated continued efficacy with up to

Todd Minars, M.D., FAAD is a board-certified dermatologist and Assistant Clinical Professor of Dermatology at the University of Miami School of Medicine. Dr. Minars is a member of the American Medial Association, American Society for Dermatologic Surgery, American Academy of Dermatology, and the Broward County Dermatologic Society.

To make an appointment with Dr. Minars and other dermatologists at Minars Dermatology, visit Minars Dermatology, or call 954-987-7512.

Minars Dermatology is located at 4020 Sheridan St., Hollywood, FL 33021

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Over-the-Counter Acne Medications Reviewed by NYC Dermatologist Dr. Nelson Novick

Posted on January 17, 2012 by Dr. Mark
Dr. Nelson Novick, MD, New York City Dermatologist

Dr. Nelson Novick, MD, New York City Dermatologist

Americans spend $330 million a year on nonprescription acne remedies, such as Clearasil® and ProActiv®. Nelson Lee Novick, M.D., New York City dermatologist, provides his expert opinion regarding their role in acne treatment.

“Over the counter (OTC) anti-acne therapies do have their place in acne control,” said Dr. Novick. “Nonprescription acne medications can be especially useful for those suffering from minor, scattered acne breakouts”, particularly those containing benzoyl peroxide, salicylic acid, or astringent (ingredients which have proven safe and effective through the years).”

“On the other hand, for persons plagued by persistent and widespread flares or deep, cystic, painful, and potential acne scars, there can be no substitute for a consultation with a dermatologist to tailor the use of prescription medications in order to treat the specific problems of the patient”, added Dr. Novick.

(Dr. Novick published his own recommendations regarding the treatment of acne scars on his Website. Learn what Dr. Novick says about acne scars and their treatment)

“Fortunately, we have the relatively recent introduction of a variety of topical prescription preparations that have proven quite effective for controlling and suppressing acne. These include combinations of topical antibiotics and retinoids, topical antibiotics and benzoyl peroxides, as well as new delivery systems to increase the penetration and efficacy of the individual ingredients while minimizing their potential for causing skin dryness or irritation,” said Dr. Novick.

“There is also a next generation set of oral antibiotics that offer the advantages of potentially fewer side effects and even the convenience of once-per-day dosing,” said Dr. Novick. Examples of oral antibiotics used to treat acne include Dynacin® and Solodyn®.

Nelson Lee Novick, M.D., FAAD, FACS is a Clinical Professor of Dermatology at Mount Sinai School of Medicine in New York City, an Attending Physician, and a former OPD Clinic Chief within the department of dermatology of the Medical Center. He is board certified both in internal medicine and dermatology and is a fellow of the American Academy of Dermatology (FAAD) and a Fellow of the American Academy of Cosmetic Surgery (FAACS).

Visit Dr. Novick’s Website at Younger Looking Without Surgery or contact the practice directly at 212-772-9300.

Dr. Nelson Novick’s dermatology practice is located at 500 East 85th St., Suite P-1, New York, New York 10028.


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Sunscreen Study Shows Routine Use Prevents Melanoma Skin Cancer

Posted on January 13, 2012 by Dr. Mark
Sunscreens

Sunscreen use prevents melanoma skin cancer

In a recent study, “Reduced melanoma after regular sunscreen use“, the benefits of regular sunscreen use is shown…once again.

Routine sunscreen use to prevent the development of melanomas has been recommended for years, though the evidence has not been substantial. Now, direct clinical evidence may finally be available.

In this recent study, 1621 randomly selected Australian residents were randomized to daily or discretionary sunscreen use, plus supplementation with 30 mg beta carotene or placebo, and observed the development of  melanoma. Participants continued to answer questions about sun exposure, sunscreen use, and melanoma formation until 2006.

11 people in the daily-sunscreen group and 22 in the discretionary-use group developed a primary melanoma by the end of follow-up.

The risk for developing any melanoma was reduced by 50% and risk for invasive melanoma was reduced by 73% in daily users of sunscreeen compared with discretionary users. No direct effects of taking beta carotene (vitamin A) were discernible.

According to the editors of Journal Watch, “the findings of this study won’t change sunscreen recommendations but do provide clear support for its use. Sunscreen alone is insufficient to eliminate melanoma risk, and the effects of all-form sun protection on melanoma mortality are unknown.”

The same trial has already shown reduced squamous cell carcinoma risk, so its clinical implications are compelling.

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Thoracic Outlet Syndrome Information Provided by Seattle Physiatrist, Dr. Richard Seroussi

Posted on January 13, 2012 by Dr. Mark
Richard Seroussi, Physiatrist

Richard Seroussi, M.D. - Seattle Spine & Sports Medicine

Dr. Richard Seroussi, a physical medicine and rehabilitation expert at Seattle Spine and Sports Medicine, provides his patients with helpful information regarding Thoracic Outlet Syndrome.

Thoracic Outlet Syndrome (TOS) results when nerves in the thoracic outlet—located between the upper ribs and shoulder get irritated by the surrounding muscles or ribs.

Symptoms of TOS include numbness and pain. The numbness may also feel like tingling, burning, and weakness in the arm and hand. The pain is most likely to occur in the neck, upper back, shoulder, or arm. Symptoms may be worsened by working with arms out in front, lifting the arm over the head (such as brushing hair), and repetitive activities (such as typing or computer use).

Other muscular or neurological conditions, such as carpal tunnel syndrome may occur with TOS.

Importantly, commonly used diagnostic tests, such as MRIs and x-rays, usually fail to show Thoracic Outlet Syndrome. To help confirm TOS diagnosis, an anesthetic block of the scalene or other pinched muscles may be performed with electromyography (EMG)  guidance, which measures electrical activity in muscles. If this procedure temporarily relieves symptoms, it is highly suggestive of TOS.

Treatment options for TOS  include manual manipulation of the neck and upper back to help correct posture, stretching and exercise, intramuscular stimulation, botulinum toxin injections (Botox, Dysport, Myobloc, Xeomin), or TOS surgery to release the muscles.

Richard Seroussi, M.D. is a physiatrist specializing in all aspects of physical rehabilitation, with an emphasis on musculoskeletal and neurologic injuries.

Dr. Seroussi is on the clinical faculty at the University of Washington, and is board-certified in PM&R, pain medicine, and electrodiagnosis. Dr. Seroussi has a Master’s degree in mechanical engineering from Princeton University, his MD from Case Western Reserve in Cleveland, and his residency in rehab medicine from the University of Washington. Some of his more satisfying work activities include interacting with patients, supervising residents from the University of Washington, and improving the work flow in our clinic in the name of better patient care.

To make an appointment with Dr. Serroussi or his colleagues, contact Seattle Spine & Sports Medicine by calling 206-861-8200 or faxing to 206-324-1178.

Seattle Spine & Sports Medicine is a comprehensive treatment clinic offering a personal approach for patients with motor vehicle, sports-related and other injuries.

Seattle Spine & Sports Medicine is located at 3213 Eastlake Avenue – East, Suite A, Seattle, WA, 98102. The medical office is situated near downtown Seattle and the University of Washington campus.

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Dermatologist Dr. Helen Torok Educates Patients About Contact Dermatitis

Posted on January 11, 2012 by Dr. Mark
Helen Torok, M.D.

Helen Torok, M.D., Dermatologist

Dr. Helen Torok, Medical Director for the Dermatology & Surgery Center at Trillium Creek, provides her patients with patient education information about contact dermatitis, a common skin condition that describes an itchy rash that results following the skin’s exposure to to an allergen or irritant.

Upon exposure to an allergen or irritant, the skin may appear either red, swollen and blistered, or dry and bumpy. In severe cases, the rash can spread to areas beyond the point of exposure.  The skin may react immediately or it may take hours to appear. The severity of the reaction can range from mild to severe depending on the individual’s allergic sensitivity to the substance and the concentration of the exposure.

A wide range of substances can trigger contact dermatitis, including:

  • Plants such as poison ivy, poison oak and poison sumac
  • Metals, particularly nickel and chromate found in earrings, watches, necklaces, buttons and belt buckles
  • Chemicals such as solvents, detergents, alkalis and acids
  • Fragrances found in lotions, shampoos, cosmetics and perfumes
  • Latex and rubber found in gloves
  • Over-the-counter topical medications including neomycin, bacitracin and hydrocortisone
  • Other substances (preservatives in leather and clothing, hair dyes, nail polish additives, glues, ….etc.)
Contact Dermatitis Feet

Contact Dermatitis from Sandals

Environmental factors can also play a significant role in contact dermatitis. Sunlight can trigger an allergic reaction to some substances, and cold air and low humidity can exacerbate the reaction.

Occupational risks are numerous in industries involving cleaning, catering, metalwork, hairdressing, healthcare and mechanical work. Most contact dermatitis that is caused by work or aggravated by work affects the hands.

It is important to pinpoint the cause of the reaction if it is not known. The dermatologists at Trillium Creek will take steps to determine the cause of the reaction, including a review of exposures and allergy testing such as patch testing.

Contact Dermatitis Shoulder

Contact Dermatitis - Shirt protected some skin from the irritant

When the cause of the reaction is known, avoidance of the substance is necessary. Some allergens, such as hair dye chemicals and glue, can penetrate rubber gloves, so glove protection may not be effective.

Your Trillium Creek Dermatology Medical Professional may prescribe a number of treatments including moisturizers, topical steroids, oral steroids and more advanced medications depending on the severity of the reaction.

Treatment can take weeks or longer, and it is important to pay close attention to ingredients in common substances such as lotions to avoid hidden triggers.

About Helen Torok, M.D.

Dr. Torok, a nationally noted, board-certified dermatologist, has been practicing medicine for over twenty-five years. She is considered an expert both in medical and cosmetic Dermatology, earning an excellent reputation in her specialty: diagnosing and treating disorders of the skin, hair, and nails. She is also known for her expertise in lip enhancement, providing full, gorgeous lips to the delight of her cosmetic patients.

Dr. Torok earned her Doctorate at Ohio State University and completed her residency in Dermatology at Case Western Reserve University. She has authored numerous articles in skin disorders and has been published in many respected medical journals.

Dr. Torok leads the Trillium Creek medical staff in treating patients using state-of-the-art technology. As experts in research and patient education, our staff is knowledgeable in the exciting breakthroughs in skin care and repair that can improve the health and appearance of your skin.

To make an appointment with Dr. Torok or her other experienced dermatologists, contact Dermatology & Surgery Center at Trillium Creek at 330-725-0569.

The primary practice location is at 5783 Wooster Pike, Medina, Ohio 44256

The practice sees patients Monday – Friday 8 AM – 5 PM, and Saturday 8 AM – 12 PM.

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Acne Treatment with Topical Retinoids Reviewed by Dermatologist, Dr. Lisa Benest

Posted on January 3, 2012 by Dr. Mark
Lisa Benest M.D. Dermatologist

Lisa Benest, M.D. Dermatologist

Topical retinoids are an important class of prescription-strength medications that are applied to the skin and commonly used for the treatment of acne.

Dermatologist Lisa Benest, M.D. of Burbank. California provides her expert opinion regarding the important role topical retinoids play in the treatment of acne, including comedonal acne (blackheads and whiteheads) and inflammatory acne.

“Almost all (acne) patients will benefit from a topical retinoid”, said Dr. Benest.

She pointed out that that “the process of unblocking these pores takes time and patience, often months.  However some results are seen almost immediately, they just continue to improve over time.  Retinoids can also be irritating, causing the skin to dry out or peel, especially if not used correctly.  Only a small amount is needed, about the size of a Tic Tac or two, depending on the size of the face.  There are different strengths of retinoids, so it is best to start on the weaker end and let your skin adjust to that, and then build up to as strong a level as the skin can tolerate.”

There are several forms of  retinoids including generic tretinoin and branded formulations, including Differin™, Retin A Micro™, Tazorac™. Some brands combine a topical retinoid with another acne medication, such as Epiduo™ (adapalene + benzoyl peroxide), Veltin™ (tretinoin + clindamycin) and Ziana™ (tretinoin + clindamycin).

“Topical retinoids (vitamin A related creams) play an integral role in the treatment and also prevention of acne”, said Dr. Benest.  “The most well known retinoid is Retin A, now available in generic form as tretinoin.”

Dr. Benest added that the “over the counter retinol is much weaker than prescription retinoids, because the retinol must get absorbed into the skin and then be converted into the retinoid.  The skin will convert only a small amount into the active ingredient.”

“The basic lesion of acne is the microcomedone, which essentially means a blockage in the pore.  This causes a back up of skin cells and oil.  Bacteria in the pore feed on this oil and then a pimple results.  Retinoids are the most effective way to eliminate these microcomedones, thus allowing the pores to eliminate the dead skin cells and oil.  Once you have taken care of these, you have basically handled the acne.”

In regards to the side effects, Dr. Benest commented on the use of topical retinoids in sunlight and by those with sensitive skin. “There is a myth that you cannot be in the sun if you use a retinoid”, said Dr. Benest.  “This is false. You can be in the sun, but it is always a good idea to use some sunscreen, especially if you are out a long time.  Studies showed that even though the skin got redder in those people using retinoids, there was actually less damage to the cell’s DNA and the skin healed more rapidly.  Retinoids have an added benefit of helping the body rid itself of damaged and precancerous cells, in addition to the famed anti-wrinkle benefits.”

Topical retinoids may be prescribed alone, particularly for cases of mild acne, or in combination with other topical or oral acne medications. They may also be prescribed for long-term use after the acne lesions have cleared to provide long-term acne control.

Lisa Benest M.D., FAAD received her medical degree at UC Irvine with further training in Los Angeles and New York. A diplomat of the American Board of Dermatology and a Fellow of the American Academy of Dermatology, she has been in private practice for over 10 years, specializing in medical and cosmetic dermatology, as well as skin cancer surgery.

Dr. Benest provides medical and cosmetic dermatology and aesthetic laser services. The dermatology office is located at 1624 W. Olive, Suite #B , Burbank, CA 91506. Appointments with Dr. Benest or one of her colleagues can be made by calling 818-729-9149.

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New Wrinkle Treatment, Belotero Balance, Approved by FDA

Posted on December 16, 2011 by Dr. Mark

A new dermal filler joins the ranks of Juvederm®, Restylane®, Radiesse®, and Sculptra® as a treatment of wrinkles and facial folds.

The U.S. FDA has approved Belotero Balance®from Merz Aesthetics for the correction of moderate-to-severe facial wrinkles and folds. This follows the approval of this wrinkle treatment in the UK, Germany, Italy, Russia, Austria and Switzerland.

Belotero® consists of hyaluronic acid, a gel that is naturally produced by the body. Hyaluronic acid is found in the body’s connective tissue, but it diminishes as a person ages. This reduction in hyaluronic acid is partially responsible for the loss of volume and sagginess of aging skin.

Injection of hyaluronic acid, such as Belotero®, into the facial tissues replaces the lost volume by “plumping” up the skin and reduces the appearance of facial folds and wrinkles. This leads to smoother skin and a more youthful appearance.

The benefits of treatment with Belotero® are immediate and may last 6 months or longer.

In a clinical study, most patients patients (103 out of 118) needed two injections of Belotero® to achieve optimal wrinkle smoothing. The smoothing effect lasted up to 6 months and then slowly faded. No serious adverse events were reported during the study though there were some reaction, such as swelling, bruising and injection-site nodules to were mild to moderate in severity.

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Patients Rate Doctors Highly Despite Changes in Healthcare

Posted on December 9, 2011 by Dr. Mark

Patients are “highly satisfied” with the medical care they receive from their own doctors in outpatient offices and clinics according to a new study published in the current issue of Health Outcomes Research in Medicine.

Doctor Patient RelationshipPatient satisfaction is one important indicator of health outcomes and plays a key role in improving health service quality.  The study, “Patient Satisfaction with Outpatient Medical Care in the U.S.“, set out to determine how individual health consumers (aka “patients”) view the care that they receive from their own doctor.

Researchers looked at data from an online survey tool, www.DrScore.com, where nearly 15,000 patients ranked doctor office visits from 2004 to 2010. Patients ranked their doctor office visit on a 10-point scale, with 10 being the highest. To prevent skewed results, they included only those physicians with 10 or more ratings and limited a patient’s ratings of a specific doctor to once every 3 months.

The average overall satisfaction rating was 9.28, with 70% (10,510) of the scores being a perfect 10. Of the remaining, 15% received a 9, with fewer than 2% of patients rating their doctors 1 or lower.

“Particularly surprising is that even a lot of patients who reported average encounters with physicians, such as average national wait times and average physician encounter time, seem to be giving full marks to their physician in terms of visit satisfaction,” said Rajesh Balkrishnan, lead study author in a story published in Modern Medicine.

Interestingly, the lower scores were posted by younger patients, those who spent less than 5 minutes with their doctors in a visit, and those who had to wait longer.

According to Dr. Balkrishnan, the high satisfaction ratings mean that patients give their doctors the benefit of the doubt, and do not blame them for factors beyond their control, such as health insurance red tape.

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