Ottilie Marsh’s referral was declined twice on the basis of a single word that had been used loosely in a letter.
Nothing here is cosmetic, and the clinic is explicit about that in its letters, because the word decides funding.
The steroid nobody explained
Quantity is the most under-explained part of topical treatment. Patients are given a tube and an instruction and left to invent the dose.
The word decides the funding. Clinicians should know that, and most of us weren’t taught it.
Dr. Ilse Marchand, dermatology
Treatment that gets used
The psychological load of a visible condition is asked about routinely at every appointment, because it does not correlate with severity and is otherwise never mentioned.
The clinic rewrote its letter template. Declines on that basis dropped to near zero within a year.
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