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we are not talking about communication between two people on the same level&#46; Our training in this field must ensure that we have a high level of skill&#46; When receiving information we must listen actively and when we are communicating information we must ensure that what we say is relevant&#44; complete&#44; verified&#44; couched in terms the patient can understand&#44; and honest&#46; Honesty is always important in medical care&#44; but in cosmetic medicine everything must be made particularly clear&#46; We must also be sincere&#44; even persuasive sometimes&#44; as well as emotive and proactive&#44; so that the patient will get involved in their own care and treatment&#59; and&#44; obviously&#44; we must talk common sense&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">But physician-patient communication is much more than just giving and receiving information&#58; starting from the great medical training we receive in our specialty&#44; 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including newspapers<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> and even on the website of our own association&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> The reason for this interest is that our work actually depends&#44; in great part&#44; on our communication skills&#46; Our diagnostic success depends fundamentally on whether or not we obtain a good clinical history &#40;more effective than any test&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> Our patients&#8217; commitment to their treatment also depends on how well we communicate with them&#44; and it has even been reported that mutual trust between the physician and the patient enhances the therapeutic value of care&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> Finally&#44; we must communicate effectively with our patients if we are to enjoy what we do&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> Poor communication will lead to growing personal dissatisfaction for both parties&#44; and little by little we will stop liking our work and even our profession&#46; Moreover&#44; several studies&#44; those of Backman<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> and Levinson<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> for example&#44; have shown that the majority of medical malpractice claims are the result of poor physician-patient communication&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10&#44;11</span></a> This association may be even more marked in cosmetic medicine given the absence of a diseased state susceptible to obvious improvement or an outcome that can be clearly demonstrated and proven by test results&#46; In our field&#44; we depend on the subjective personal satisfaction of a person who sees an improvement in the appearance of their skin&#44; independent of more or less objective evidence&#46; It is important to remember that in cosmetic medicine we are not dealing with a patient who requires a cure &#40;not the primary need&#41;&#59; rather&#44; our patients come to us with a desire or a hope&#44; even though some of them may view their desire as a necessity and some may even present their wishes to us as a necessity&#46; Moreover&#44; our patients come to us voluntarily and we can also choose whether or not we will treat them&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite everything that has been said about communication in healthcare and the large number of articles that have been written on the topic&#44; we have not found any publications in the literature referring specifically to physician-patient communication in cosmetic dermatology&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Objective</span><p id="par0025" class="elsevierStylePara elsevierViewall">Our objective in this article was to try to identify some protocols&#44; skills&#44;and strategies that favor communication in cosmetic dermatology&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Material&#44; Method and Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">To achieve our objective&#44; we focused on 3 closely related human skills that determine how we listen to and communicate with the cosmetic dermatology patient&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the resulting 3-pillar model &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The 3 pillars are as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel"><span class="elsevierStyleItalic">-</span></span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Assertiveness&#58;</span> the ability to express oneself clearly and directly&#44; saying what we want to say without offending or disparaging the other person and being aware of and defending our own rights while respecting others&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel"><span class="elsevierStyleItalic">-</span></span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Empathy&#58;</span> the human ability to understand and share the feelings of other people&#44; without necessarily thinking in the same way as that person&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel"><span class="elsevierStyleItalic">-</span></span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Critical judgement&#58;</span> the ability to think critically&#44; leading us to verify&#44; analyze&#44; understand&#44; and evaluate what we observe in the patient&#8212;observations that inform our initial and differential diagnoses &#40;in cosmetic dermatology taking into account the possibility of body dysmorphic disorder and other such conditions&#41;&#8212;and to analyze and check our treatment decision&#44; as we would in any other branch of our specialty&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">13&#44;14</span></a></p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">With respect to assertiveness&#44; our reason for choosing to work in cosmetic dermatology should be because we like the field and we want to help our patients&#44; because nobody is obliging us to choose this specialty&#46; We must have a clear idea of what we want to do within the subspecialty and what we want to achieve with our treatments&#46; And we also need to be clear about what we do not want to do&#46; Moreover&#44; we have be able to defend and explain our position&#44; while respecting our patients and their feelings&#46; In this context&#44; it is important that we know how to use the following techniques when talking to patients&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We should know how to use &#8220;I&#8221; messages&#44; that is&#44; statements in which the speaker expresses what he or she feels and would like without belittling the other person&#58; &#8220;I think that &#46;&#46;&#46;&#8221;&#44; &#8220;I have not found that technique to be useful&#8221;&#44; &#8220;I don&#8217;t share your opinion in that respect&#8221;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Avoid value judgments&#8212;very important in cosmetic dermatology&#46; Avoid comments like the following&#58; &#8220;You should not worry so much about your appearance&#8221;&#44; &#8220;You are worrying about a problem that does not exist&#8221;&#44; &#8220;That is not important&#8221;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Know how to say <span class="elsevierStyleItalic">no</span>&#46; If at any time you are uncomfortable with something a patient asks you to do or feel that you should not treat the patient based on your critical judgment&#44; say <span class="elsevierStyleItalic">no</span> in an assertive way&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Taking care of and protecting our appearance is a praiseworthy and useful quality that helps us adapt to change&#44; get on with other people&#44; and cope with difficult situations&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> As well as being part of our identity&#44; our physical appearance and its expressions are&#44; from a very young age&#44; an important component of our emotional world and our ability to connect with other people&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> The results of studies carried out using the DEBIE questionnaire have shown that there is a relationship between cosmetic dermatology and emotional well-being&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">15&#44;16</span></a> The findings of those studies also indicate that it is people who are more assertive and report greater baseline well-being who value these treatments and the benefits they can offer in their daily lives&#46; And this finding illustrates what we are really looking for&#58; patients who want to improve themselves and take care of themselves because they are well and not because they are unhappy&#46; We must use our critical judgment to detect unrealistic expectations and make a differential diagnosis&#46; It is important to make it clear to the patient that the aim of a treatment is never to halt the aging process but rather to help them age more healthily and in consonance with their mental vitality&#46; As dermatologists&#44; our objective is to take care of the skin and keep it functionally younger&#44; healthier&#44; and more harmonious and that will result in aesthetic improvements&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Critical thinking</span> is a cognitive skill and natural ability that we use in all our consultations as physicians&#46; We analyze&#44; evaluate&#44; and synthesize all the information we glean from a consultation&#46; Critical thinking and judgement involves careful observation&#44; applying the scientific method&#44; drawing on experience&#44; and using our reasoning faculties&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> And in the case of cosmetic dermatology it also draws on our creative&#44; imaginative&#44; and artistic reasoning&#46; Critical judgement comprises 2 main components&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Cognitive skills&#44; that is&#44; our knowledge&#8212;mainly medical&#8212;which we use to establish a diagnosis and differential diagnosis &#40;very important in this setting&#41; and to decide on the best treatment plan&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">A disposition to verify and to analyze all the factors from different standpoints &#40;checking the information and our decision&#44; evaluating the pros and cons&#41;&#46; Although we have a duty to check on our knowledge&#44; we have to keep our patients safe and communicate that safety to them&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a></p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Empathy</span> is the central pillar of our model&#44; the key to complete and correct communication with the patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;12</span></a> There are different levels of empathy&#8212;natural&#44; basic&#44; advanced&#44; and very advanced&#8212;and our profession demands a very advanced level&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> Empathy relates to our ability to understand our patient&#39;s feelings and to communicate that understanding to them&#44; either verbally &#40;for example&#44; &#8220;I understand the concerns you have about your skin&#8221;&#41; or nonverbally &#40;for example&#44; with an appropriate facial expression&#41;&#46; Empathy requires us to reflect and to make a conscious effort to recognize the other as a person with emotions&#46; It requires patience &#40;some patients may irritate us but we have to control those feelings so that we can be open to everyone&#44; whoever they are and whatever their needs&#41;&#46; Finally&#44; it requires courage because it can generate feelings and emotional reactions that we have to control&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> However&#44; it is a source of great motivation and creativity&#46; Empathy is an attitude attained through active listening&#44; in this case to the cosmetic dermatology patient&#44; without making assumptions and with the intent of helping the person &#40;by listening carefully to what they say&#44; treating them&#44; or sometimes simply making a referral&#41;&#46; Empathy enables us to manage the emotions that arise during the consultation using a variety of strategies&#44; including confrontation&#44; amplification&#44; minimization&#44; to mention just a few&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> And it also involves a number of functions&#58; catharsis&#44; change&#44; exculpation&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> In the case of empathy&#8212;unlike sympathy&#8212;the clinician is not emotionally involved but is&#44; at all times&#44; aware of the patient&#39;s feelings&#44; and of their own&#46; Nor is empathy the same as cordiality&#44; which is a habit and may be automatic&#44; and does not involve any reflection or effort&#46; Cordiality is what happens when we greet our patients when they arrive and when we show them out at the end of the consultation&#8212;the moment when we recognize the other as a person&#46; However&#44; a friendly and cordial atmosphere &#40;&#8220;Welcome&#44; please come in&#8221;&#41; favors an empathic interaction&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;6&#44;12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Nevertheless&#44; there has to be a limit to everything&#44; and we know that unlimited listening is neither possible nor opportune&#46; Moreover&#44; empathy must always be accompanied by assertiveness&#58; we must know how to say no to certain requests and to set limits in order to avoid contraindications or iatrogenesis due to excessive empathy&#46; For example&#44; in the case of an aggressive or demanding patient&#44; it is important to guard against excessive empathy that the patient might interpret as insecurity or a lack of assertiveness on your part&#46; Similarly&#44; a manipulative patient looking for someone to blame may interpret empathy as agreement&#46; Such a situation has to be managed carefully and requires exculpatory empathy that affirms the physician&#39;s good intentions&#44; because a clinician who is embarrassed cannot be empathic&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">An essential skill in our subspecialty &#40;even more so now that patients are influenced by the ubiquitous coverage of these issues in advertising and the media&#41; is to be able to use our critical judgment to identify patients with unrealistically high expectations of what can be achieved&#46; With assertiveness and empathy&#44; we must strive to reduce these expectations and bring them into line with reality&#46; If this proves impossible and the patient continues to have unrealistic expectations&#44; we can&#44; once again with empathy and assertiveness&#44; refuse to treat them&#46; This is very important if we are to avoid unnecessary frustrations&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In cosmetic medicine&#44; as in any other medical specialty&#44; our practice is guided by normal medical ethics&#58; striving for moral excellence&#44; ensuring patient privacy &#40;very important in cosmetic medicine&#41;&#44; obtaining informed consent&#44; and sharing decision making with our patients&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> All our team members must follow the same line&#44; being friendly&#44; kind&#44; and empathic&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">With an eminently practical intent&#44; in <a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2-7</a> we present 6 clinical cases illustrated with images professionally characterized by Marta Mard&#243; &#40;Higher Degree in Dramatic Arts&#44; Master in Interpretation&#41;&#46; These figures represent 6 different patients attending our consultation who explain what they want&#44; each with their own personality and personal circumstances&#46; We could analyze the possible dialogue for each case in detail&#44; taking into account the variables mentioned above&#58; assertiveness&#44; empathy&#44; and critical judgment&#46; However&#44; for reasons of space&#44; we have limited ourselves to commenting in the figure legend on a few simple alternatives for each case&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion and Conclusions</span><p id="par0115" class="elsevierStylePara elsevierViewall">Our message can be summarized as follows&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall">Assertiveness&#44; empathy and critical judgment are essential skills in our communication with the cosmetic patient and for properly managing their expectations&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">We must enjoy our work and understand our patients and their hopes and wishes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">Our medical and professional ethics must inform everything we do&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">It is important that the patient be in a good emotional state before treatment&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">We must do a lot of expectations management&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">We can say <span class="elsevierStyleItalic">no</span> when we do not consider it appropriate to treat a patient&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cosmetic dermatology deals with the beauty and appearance of the skin&#8211;a most important element of body image&#46; Treatments used in cosmetic dermatology &#40;hygiene&#44; hydration&#44; protection&#44; repair&#41; aim to enhance the characteristics of the skin&#44; its anatomy&#44; its function&#44; and its vitality&#44; to produce aesthetic improvements&#46; Communication with the patient is essential in medical consultations and we believe that it has special connotations in cosmetic dermatology that must be taken into account&#46; In this article&#44; we present a 3-pillar model for communication with cosmetic dermatology patients that rests on 3 skills&#58; assertiveness&#44; empathy&#44; and critical judgement&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La Dermatolog&#237;a Est&#233;tica se ocupa de la belleza y apariencia de la piel&#44; una parte important&#237;sima de la imagen corporal&#46; Los tratamientos utilizados en Dermatolog&#237;a Est&#233;tica &#40;higiene&#44; hidrataci&#243;n&#44; protecci&#243;n&#44; reparaci&#243;n&#41; buscan potenciar las caracter&#237;sticas propias de la piel&#44; en su anatom&#237;a&#44; funci&#243;n y vitalidad&#44; y esto se traduce en mejoras del aspecto est&#233;tico&#46; La comunicaci&#243;n con el paciente es fundamental en la consulta m&#233;dica y entendemos que la Dermatolog&#237;a Est&#233;tica tiene connotaciones especiales que deben considerarse&#46; En este art&#237;culo se presenta un modelo propio de tres pilares en la comunicaci&#243;n con el paciente est&#233;tico y se exponen tres habilidades humanas como dichos pilares&#58; asertividad&#44; empat&#237;a y juicio cr&#237;tico&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;nez-Gonz&#225;lez MC&#44; Mart&#237;nez-Gonz&#225;lez RA&#44; Guerra-Tapia A&#46; Dermatolog&#237;a Est&#233;tica&#58; habilidades humanas claves en comunicaci&#243;n&#46; Modelo de los tres pilares&#46; Actas Dermo-Sifiliogr&#225;ficas&#46; 2019&#59;110&#58;794&#8211;799&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Communication in cosmetic practice&#58; Clinical case 1&#46; This person wants to <span class="elsevierStyleItalic">eliminate</span> her frown lines&#44; but without any of &#34;those weird injections<span class="elsevierStyleItalic">&#8221;</span>&#46; The physician must be patient&#59; sometimes patients seem to be looking for magic&#46; In this case&#44; the patient is an educated and well informed person&#44; who is afraid&#46; Following a complete physical examination&#44; the physician will have to explain what botulinum toxin is&#44; the proven safety record and limited durability of the treatment&#44; and the desire to seek natural-looking results&#46; We have to change the patient&#39;s perception so that the person who comes into the consultation expressing doubts and fear leaves in a more calm frame of mind&#46; And she will request an appointment for treatment when she makes her decision&#46;</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Communication in cosmetic dermatology&#58; Clinical case 2&#46; In this case&#44; we can help the patient a great deal by doing very little&#46; For example&#44; simply by offering her a tissue when she dissolves into tears&#44; we can facilitate catharsis&#46; The gesture shows your respect and indicates that you support and empathize with the speaker&#46; This gives the patient permission to express her emotion in all its intensity and in that catharsis she will probably realize that there is no point in undergoing a cosmetic procedure or treatment at this time&#46; However&#44; you can offer her a clinical assessment and recommend home cosmeceutical therapies&#46; Later&#44; when she is feeling better&#44; both in her mental state and her skin due to the home treatment&#44; you can suggest treatments designed to reduce the overall photoaging of her skin&#46; In this way&#44; you can establish an affective connection&#44; using an empathic attitude to ensure that the patient does not lose her trust in you as a person and&#44; at the same time&#44; continues to see you as a health agent interested in enhancing her wellbeing&#46; Sometimes postponing treatment is the best way to proceed&#44; so that treatment can be started later with greater confidence in the results and in the acquisition of a routine&#46; At the same time&#44; the decision can reaffirm us as doctors&#46; The patient will definitely leave the consultation feeling much better because she has been listened to&#44; cared for&#44; and understood&#46; And she will leave with hope and with the enthusiasm and motivation to return in the future&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Communication in cosmetic dermatology&#58; Clinical case 3&#46; This case presents several challenges&#58; the patient is asking for a cure for a chronic disease and&#44; what is more&#44; it appears that this is what she has understood from what she was told when receiving treatment in a hospital&#46; We must clarify the real situation&#44; patiently explaining what rosacea is and what laser therapy can achieve and further add that any treatment will require maintenance&#46; In effect&#44; we have to bring her expectations into line with reality&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Communication in cosmetic dermatology&#58; Clinical case 4&#46; In this case&#44; the physician may be surprised for a number of reasons&#46; The patient is talking about a defect we do not perceive&#46; It is possible that the patient has body dysmorphic disorder&#46; Furthermore&#44; she may be lying when she says that the previous lip augmentation procedure with hyaluronic filler was done &#8220;ages ago&#8221;&#46; Looking at her lips&#44; we can see that the procedure was more likely performed recently or perhaps it was not done with hyaluronic filler but rather with some other material that would contraindicate hyaluronic therapy&#46; The patient also complains about the results of earlier treatment&#46; In this situation&#44; without hurting her feelings&#44; the best course of action would be to tell the patient that you are unable to offer her that treatment because&#44; medically&#44; you do not consider it to be indicated at this time&#46; In this exchange it is unnecessary to either contradict or agree with the patient&#46;</p>"
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        "texto" => "<p id="par0155" class="elsevierStylePara elsevierViewall">We would like to thank Marta Mard&#243; &#40;Higher Degree in Dramatic Arts - Master in Interpretation&#41; for her work characterizing the clinical cases&#46;</p>"
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Practical Dermatology
Key Communication Skills in Cosmetic Dermatology: A 3-Pillar Model
Dermatología Estética: habilidades humanas claves en comunicación. Modelo de los tres pilares
M.C. Martínez-Gonzáleza,
Corresponding author
covadie@gmail.com

Corresponding author.
, R.A. Martínez-Gonzálezb, A. Guerra-Tapiac,d,e
a Dermatología, Consulta privada, Oviedo, Asturias, Spain
b Departamento de Ciencias de la Educación, Universidad de Oviedo, Oviedo, Asturias, Spain
c Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
d Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
e Dermatología, Universidad Internacional de La Rioja, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Our job is to care for our patients&#44; irrespective of what they may ask us to do&#46; We care for people and we work directly with the public as both receivers and transmitters of information&#46; Consequently&#44; we need to have a good understanding of the basic characteristics and component elements of communication &#40;based on an understandable code in an appropriate channel without interference or noise if possible&#41; and also be aware of the different types of communication we use &#40;verbal&#44; gestural&#44; and paraverbal&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;5</span></a> Mastery of all these parameters is a basic requirement in our profession&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this case&#44; we are not talking about communication between two people on the same level&#46; Our training in this field must ensure that we have a high level of skill&#46; When receiving information we must listen actively and when we are communicating information we must ensure that what we say is relevant&#44; complete&#44; verified&#44; couched in terms the patient can understand&#44; and honest&#46; Honesty is always important in medical care&#44; but in cosmetic medicine everything must be made particularly clear&#46; We must also be sincere&#44; even persuasive sometimes&#44; as well as emotive and proactive&#44; so that the patient will get involved in their own care and treatment&#59; and&#44; obviously&#44; we must talk common sense&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">But physician-patient communication is much more than just giving and receiving information&#58; starting from the great medical training we receive in our specialty&#44; communication is more than just being polite to our patients&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> Owing to its complexity&#44; clinical communication is an academic discipline in its own right&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> This has a lot to do with the fact that it requires very advanced emotional management skills&#59; we have to reflect on actions and manage feelings and expectations &#40;this last so very important in cosmetic medicine&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> Because of the complexity and importance of physician-patient communication&#44; this topic is not only dealt with in articles in medical journals&#44; it has also been the subject of veritable treatises&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;4</span></a> In fact&#44; clinical communication is an increasingly on-trend topic and we find references to it in very diverse media&#44; including newspapers<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> and even on the website of our own association&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> The reason for this interest is that our work actually depends&#44; in great part&#44; on our communication skills&#46; Our diagnostic success depends fundamentally on whether or not we obtain a good clinical history &#40;more effective than any test&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> Our patients&#8217; commitment to their treatment also depends on how well we communicate with them&#44; and it has even been reported that mutual trust between the physician and the patient enhances the therapeutic value of care&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> Finally&#44; we must communicate effectively with our patients if we are to enjoy what we do&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> Poor communication will lead to growing personal dissatisfaction for both parties&#44; and little by little we will stop liking our work and even our profession&#46; Moreover&#44; several studies&#44; those of Backman<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> and Levinson<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> for example&#44; have shown that the majority of medical malpractice claims are the result of poor physician-patient communication&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10&#44;11</span></a> This association may be even more marked in cosmetic medicine given the absence of a diseased state susceptible to obvious improvement or an outcome that can be clearly demonstrated and proven by test results&#46; In our field&#44; we depend on the subjective personal satisfaction of a person who sees an improvement in the appearance of their skin&#44; independent of more or less objective evidence&#46; It is important to remember that in cosmetic medicine we are not dealing with a patient who requires a cure &#40;not the primary need&#41;&#59; rather&#44; our patients come to us with a desire or a hope&#44; even though some of them may view their desire as a necessity and some may even present their wishes to us as a necessity&#46; Moreover&#44; our patients come to us voluntarily and we can also choose whether or not we will treat them&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite everything that has been said about communication in healthcare and the large number of articles that have been written on the topic&#44; we have not found any publications in the literature referring specifically to physician-patient communication in cosmetic dermatology&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Objective</span><p id="par0025" class="elsevierStylePara elsevierViewall">Our objective in this article was to try to identify some protocols&#44; skills&#44;and strategies that favor communication in cosmetic dermatology&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Material&#44; Method and Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">To achieve our objective&#44; we focused on 3 closely related human skills that determine how we listen to and communicate with the cosmetic dermatology patient&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the resulting 3-pillar model &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The 3 pillars are as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel"><span class="elsevierStyleItalic">-</span></span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Assertiveness&#58;</span> the ability to express oneself clearly and directly&#44; saying what we want to say without offending or disparaging the other person and being aware of and defending our own rights while respecting others&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel"><span class="elsevierStyleItalic">-</span></span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Empathy&#58;</span> the human ability to understand and share the feelings of other people&#44; without necessarily thinking in the same way as that person&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel"><span class="elsevierStyleItalic">-</span></span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Critical judgement&#58;</span> the ability to think critically&#44; leading us to verify&#44; analyze&#44; understand&#44; and evaluate what we observe in the patient&#8212;observations that inform our initial and differential diagnoses &#40;in cosmetic dermatology taking into account the possibility of body dysmorphic disorder and other such conditions&#41;&#8212;and to analyze and check our treatment decision&#44; as we would in any other branch of our specialty&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">13&#44;14</span></a></p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">With respect to assertiveness&#44; our reason for choosing to work in cosmetic dermatology should be because we like the field and we want to help our patients&#44; because nobody is obliging us to choose this specialty&#46; We must have a clear idea of what we want to do within the subspecialty and what we want to achieve with our treatments&#46; And we also need to be clear about what we do not want to do&#46; Moreover&#44; we have be able to defend and explain our position&#44; while respecting our patients and their feelings&#46; In this context&#44; it is important that we know how to use the following techniques when talking to patients&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We should know how to use &#8220;I&#8221; messages&#44; that is&#44; statements in which the speaker expresses what he or she feels and would like without belittling the other person&#58; &#8220;I think that &#46;&#46;&#46;&#8221;&#44; &#8220;I have not found that technique to be useful&#8221;&#44; &#8220;I don&#8217;t share your opinion in that respect&#8221;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Avoid value judgments&#8212;very important in cosmetic dermatology&#46; Avoid comments like the following&#58; &#8220;You should not worry so much about your appearance&#8221;&#44; &#8220;You are worrying about a problem that does not exist&#8221;&#44; &#8220;That is not important&#8221;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Know how to say <span class="elsevierStyleItalic">no</span>&#46; If at any time you are uncomfortable with something a patient asks you to do or feel that you should not treat the patient based on your critical judgment&#44; say <span class="elsevierStyleItalic">no</span> in an assertive way&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Taking care of and protecting our appearance is a praiseworthy and useful quality that helps us adapt to change&#44; get on with other people&#44; and cope with difficult situations&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> As well as being part of our identity&#44; our physical appearance and its expressions are&#44; from a very young age&#44; an important component of our emotional world and our ability to connect with other people&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> The results of studies carried out using the DEBIE questionnaire have shown that there is a relationship between cosmetic dermatology and emotional well-being&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">15&#44;16</span></a> The findings of those studies also indicate that it is people who are more assertive and report greater baseline well-being who value these treatments and the benefits they can offer in their daily lives&#46; And this finding illustrates what we are really looking for&#58; patients who want to improve themselves and take care of themselves because they are well and not because they are unhappy&#46; We must use our critical judgment to detect unrealistic expectations and make a differential diagnosis&#46; It is important to make it clear to the patient that the aim of a treatment is never to halt the aging process but rather to help them age more healthily and in consonance with their mental vitality&#46; As dermatologists&#44; our objective is to take care of the skin and keep it functionally younger&#44; healthier&#44; and more harmonious and that will result in aesthetic improvements&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Critical thinking</span> is a cognitive skill and natural ability that we use in all our consultations as physicians&#46; We analyze&#44; evaluate&#44; and synthesize all the information we glean from a consultation&#46; Critical thinking and judgement involves careful observation&#44; applying the scientific method&#44; drawing on experience&#44; and using our reasoning faculties&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> And in the case of cosmetic dermatology it also draws on our creative&#44; imaginative&#44; and artistic reasoning&#46; Critical judgement comprises 2 main components&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Cognitive skills&#44; that is&#44; our knowledge&#8212;mainly medical&#8212;which we use to establish a diagnosis and differential diagnosis &#40;very important in this setting&#41; and to decide on the best treatment plan&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">A disposition to verify and to analyze all the factors from different standpoints &#40;checking the information and our decision&#44; evaluating the pros and cons&#41;&#46; Although we have a duty to check on our knowledge&#44; we have to keep our patients safe and communicate that safety to them&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a></p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Empathy</span> is the central pillar of our model&#44; the key to complete and correct communication with the patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;12</span></a> There are different levels of empathy&#8212;natural&#44; basic&#44; advanced&#44; and very advanced&#8212;and our profession demands a very advanced level&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> Empathy relates to our ability to understand our patient&#39;s feelings and to communicate that understanding to them&#44; either verbally &#40;for example&#44; &#8220;I understand the concerns you have about your skin&#8221;&#41; or nonverbally &#40;for example&#44; with an appropriate facial expression&#41;&#46; Empathy requires us to reflect and to make a conscious effort to recognize the other as a person with emotions&#46; It requires patience &#40;some patients may irritate us but we have to control those feelings so that we can be open to everyone&#44; whoever they are and whatever their needs&#41;&#46; Finally&#44; it requires courage because it can generate feelings and emotional reactions that we have to control&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> However&#44; it is a source of great motivation and creativity&#46; Empathy is an attitude attained through active listening&#44; in this case to the cosmetic dermatology patient&#44; without making assumptions and with the intent of helping the person &#40;by listening carefully to what they say&#44; treating them&#44; or sometimes simply making a referral&#41;&#46; Empathy enables us to manage the emotions that arise during the consultation using a variety of strategies&#44; including confrontation&#44; amplification&#44; minimization&#44; to mention just a few&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> And it also involves a number of functions&#58; catharsis&#44; change&#44; exculpation&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> In the case of empathy&#8212;unlike sympathy&#8212;the clinician is not emotionally involved but is&#44; at all times&#44; aware of the patient&#39;s feelings&#44; and of their own&#46; Nor is empathy the same as cordiality&#44; which is a habit and may be automatic&#44; and does not involve any reflection or effort&#46; Cordiality is what happens when we greet our patients when they arrive and when we show them out at the end of the consultation&#8212;the moment when we recognize the other as a person&#46; However&#44; a friendly and cordial atmosphere &#40;&#8220;Welcome&#44; please come in&#8221;&#41; favors an empathic interaction&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;6&#44;12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Nevertheless&#44; there has to be a limit to everything&#44; and we know that unlimited listening is neither possible nor opportune&#46; Moreover&#44; empathy must always be accompanied by assertiveness&#58; we must know how to say no to certain requests and to set limits in order to avoid contraindications or iatrogenesis due to excessive empathy&#46; For example&#44; in the case of an aggressive or demanding patient&#44; it is important to guard against excessive empathy that the patient might interpret as insecurity or a lack of assertiveness on your part&#46; Similarly&#44; a manipulative patient looking for someone to blame may interpret empathy as agreement&#46; Such a situation has to be managed carefully and requires exculpatory empathy that affirms the physician&#39;s good intentions&#44; because a clinician who is embarrassed cannot be empathic&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">An essential skill in our subspecialty &#40;even more so now that patients are influenced by the ubiquitous coverage of these issues in advertising and the media&#41; is to be able to use our critical judgment to identify patients with unrealistically high expectations of what can be achieved&#46; With assertiveness and empathy&#44; we must strive to reduce these expectations and bring them into line with reality&#46; If this proves impossible and the patient continues to have unrealistic expectations&#44; we can&#44; once again with empathy and assertiveness&#44; refuse to treat them&#46; This is very important if we are to avoid unnecessary frustrations&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In cosmetic medicine&#44; as in any other medical specialty&#44; our practice is guided by normal medical ethics&#58; striving for moral excellence&#44; ensuring patient privacy &#40;very important in cosmetic medicine&#41;&#44; obtaining informed consent&#44; and sharing decision making with our patients&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> All our team members must follow the same line&#44; being friendly&#44; kind&#44; and empathic&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">With an eminently practical intent&#44; in <a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2-7</a> we present 6 clinical cases illustrated with images professionally characterized by Marta Mard&#243; &#40;Higher Degree in Dramatic Arts&#44; Master in Interpretation&#41;&#46; These figures represent 6 different patients attending our consultation who explain what they want&#44; each with their own personality and personal circumstances&#46; We could analyze the possible dialogue for each case in detail&#44; taking into account the variables mentioned above&#58; assertiveness&#44; empathy&#44; and critical judgment&#46; However&#44; for reasons of space&#44; we have limited ourselves to commenting in the figure legend on a few simple alternatives for each case&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion and Conclusions</span><p id="par0115" class="elsevierStylePara elsevierViewall">Our message can be summarized as follows&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall">Assertiveness&#44; empathy and critical judgment are essential skills in our communication with the cosmetic patient and for properly managing their expectations&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">We must enjoy our work and understand our patients and their hopes and wishes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">Our medical and professional ethics must inform everything we do&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">It is important that the patient be in a good emotional state before treatment&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">We must do a lot of expectations management&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">We can say <span class="elsevierStyleItalic">no</span> when we do not consider it appropriate to treat a patient&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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            0 => "Dermatology"
            1 => "Esthetics"
            2 => "Communication"
            3 => "Pillars"
            4 => "Empathy"
            5 => "Critical judgement"
            6 => "Assertiveness"
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            0 => "Dermatolog&#237;a"
            1 => "Est&#233;tica"
            2 => "Comunicaci&#243;n"
            3 => "Pilares"
            4 => "Empat&#237;a"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cosmetic dermatology deals with the beauty and appearance of the skin&#8211;a most important element of body image&#46; Treatments used in cosmetic dermatology &#40;hygiene&#44; hydration&#44; protection&#44; repair&#41; aim to enhance the characteristics of the skin&#44; its anatomy&#44; its function&#44; and its vitality&#44; to produce aesthetic improvements&#46; Communication with the patient is essential in medical consultations and we believe that it has special connotations in cosmetic dermatology that must be taken into account&#46; In this article&#44; we present a 3-pillar model for communication with cosmetic dermatology patients that rests on 3 skills&#58; assertiveness&#44; empathy&#44; and critical judgement&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La Dermatolog&#237;a Est&#233;tica se ocupa de la belleza y apariencia de la piel&#44; una parte important&#237;sima de la imagen corporal&#46; Los tratamientos utilizados en Dermatolog&#237;a Est&#233;tica &#40;higiene&#44; hidrataci&#243;n&#44; protecci&#243;n&#44; reparaci&#243;n&#41; buscan potenciar las caracter&#237;sticas propias de la piel&#44; en su anatom&#237;a&#44; funci&#243;n y vitalidad&#44; y esto se traduce en mejoras del aspecto est&#233;tico&#46; La comunicaci&#243;n con el paciente es fundamental en la consulta m&#233;dica y entendemos que la Dermatolog&#237;a Est&#233;tica tiene connotaciones especiales que deben considerarse&#46; En este art&#237;culo se presenta un modelo propio de tres pilares en la comunicaci&#243;n con el paciente est&#233;tico y se exponen tres habilidades humanas como dichos pilares&#58; asertividad&#44; empat&#237;a y juicio cr&#237;tico&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;nez-Gonz&#225;lez MC&#44; Mart&#237;nez-Gonz&#225;lez RA&#44; Guerra-Tapia A&#46; Dermatolog&#237;a Est&#233;tica&#58; habilidades humanas claves en comunicaci&#243;n&#46; Modelo de los tres pilares&#46; Actas Dermo-Sifiliogr&#225;ficas&#46; 2019&#59;110&#58;794&#8211;799&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Model of the three pillars of communication in cosmetic practice&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Communication in cosmetic practice&#58; Clinical case 1&#46; This person wants to <span class="elsevierStyleItalic">eliminate</span> her frown lines&#44; but without any of &#34;those weird injections<span class="elsevierStyleItalic">&#8221;</span>&#46; The physician must be patient&#59; sometimes patients seem to be looking for magic&#46; In this case&#44; the patient is an educated and well informed person&#44; who is afraid&#46; Following a complete physical examination&#44; the physician will have to explain what botulinum toxin is&#44; the proven safety record and limited durability of the treatment&#44; and the desire to seek natural-looking results&#46; We have to change the patient&#39;s perception so that the person who comes into the consultation expressing doubts and fear leaves in a more calm frame of mind&#46; And she will request an appointment for treatment when she makes her decision&#46;</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Communication in cosmetic dermatology&#58; Clinical case 2&#46; In this case&#44; we can help the patient a great deal by doing very little&#46; For example&#44; simply by offering her a tissue when she dissolves into tears&#44; we can facilitate catharsis&#46; The gesture shows your respect and indicates that you support and empathize with the speaker&#46; This gives the patient permission to express her emotion in all its intensity and in that catharsis she will probably realize that there is no point in undergoing a cosmetic procedure or treatment at this time&#46; However&#44; you can offer her a clinical assessment and recommend home cosmeceutical therapies&#46; Later&#44; when she is feeling better&#44; both in her mental state and her skin due to the home treatment&#44; you can suggest treatments designed to reduce the overall photoaging of her skin&#46; In this way&#44; you can establish an affective connection&#44; using an empathic attitude to ensure that the patient does not lose her trust in you as a person and&#44; at the same time&#44; continues to see you as a health agent interested in enhancing her wellbeing&#46; Sometimes postponing treatment is the best way to proceed&#44; so that treatment can be started later with greater confidence in the results and in the acquisition of a routine&#46; At the same time&#44; the decision can reaffirm us as doctors&#46; The patient will definitely leave the consultation feeling much better because she has been listened to&#44; cared for&#44; and understood&#46; And she will leave with hope and with the enthusiasm and motivation to return in the future&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Communication in cosmetic dermatology&#58; Clinical case 3&#46; This case presents several challenges&#58; the patient is asking for a cure for a chronic disease and&#44; what is more&#44; it appears that this is what she has understood from what she was told when receiving treatment in a hospital&#46; We must clarify the real situation&#44; patiently explaining what rosacea is and what laser therapy can achieve and further add that any treatment will require maintenance&#46; In effect&#44; we have to bring her expectations into line with reality&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Communication in cosmetic dermatology&#58; Clinical case 4&#46; In this case&#44; the physician may be surprised for a number of reasons&#46; The patient is talking about a defect we do not perceive&#46; It is possible that the patient has body dysmorphic disorder&#46; Furthermore&#44; she may be lying when she says that the previous lip augmentation procedure with hyaluronic filler was done &#8220;ages ago&#8221;&#46; Looking at her lips&#44; we can see that the procedure was more likely performed recently or perhaps it was not done with hyaluronic filler but rather with some other material that would contraindicate hyaluronic therapy&#46; The patient also complains about the results of earlier treatment&#46; In this situation&#44; without hurting her feelings&#44; the best course of action would be to tell the patient that you are unable to offer her that treatment because&#44; medically&#44; you do not consider it to be indicated at this time&#46; In this exchange it is unnecessary to either contradict or agree with the patient&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Communication in cosmetic dermatology&#58; Clinical case 5&#46; This patient has a demanding attitude and she wants to <span class="elsevierStyleItalic">eliminate</span> spots&#46; While the word <span class="elsevierStyleItalic">eliminate</span> probably bothers us&#44; we think we might be able to help her&#46; Furthermore&#44; she already believes that none of the lesions she has are of any concern&#46; In these circumstances&#44; it is important to maintain a scientific and medical attitude&#58; &#8220;I see&#8230;Please come in&#46; The first step is to carry out a physical examination so that I can assess what kind of spots we are talking about&#8221;&#46; After performing the examination and any necessary tests&#8212;and if the only findings are lentigines and ephelides&#8212;we can explain the situation to the patient&#46; It is important to adjust the patient&#39;s expectations&#44; explaining that we can help her <span class="elsevierStyleItalic">to improve</span> her spots&#44; and discuss the techniques we consider could be useful&#46; Once we have given this explanation and recommended measures she can implement herself at home&#44; we can leave it up to the patient to decide whether she wants to undergo further treatment&#46; In this case&#44; with empathy and assertiveness&#44; our aim is to change the patient&#39;s attitude&#46; The patient accepts our empathic behavior and&#44; at the same time&#44; is surprised by our scientific and safe approach&#46; It is probable that she will change her behavior from imposing her will to asking for and accepting our advice&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Communication in cosmetic dermatology&#58; Clinical case 6&#46; Finally&#44; the sixth patient is someone who wants to improve the quality of her skin and her approach is similar to our own&#46; She is already a patient and she trusts our work because we have treated her cancer&#46; Her self-esteem is high and her attitude is assertive&#46; Normally&#44; with a patient like this&#44; the relationship will be fine and the treatment will go smoothly&#46; This kind of patient is common in dermatology&#46;</p>"
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              ]
            ]
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                  "host" => array:1 [
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                  "contribucion" => array:1 [
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                        "fecha" => "1994"
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                  ]
                  "host" => array:1 [
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        "texto" => "<p id="par0155" class="elsevierStylePara elsevierViewall">We would like to thank Marta Mard&#243; &#40;Higher Degree in Dramatic Arts - Master in Interpretation&#41; for her work characterizing the clinical cases&#46;</p>"
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Article information
ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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