How to Integrate Psychiatry Tools for Optimized Dermatologic Care

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At the 10th Annual Fall Clinical PA/NP Conference in Orlando, Florida, Evan Rieder, MD, who is dually trained in psychiatry and dermatology, presented a session titled “Top Psychologically Informed Tips to Maximize Practice Efficiency.”¹ Drawing on his unique background, Rieder emphasized that nearly every dermatologic encounter contains a psychological component. He offered practical, psychiatry-based strategies for managing challenging patient behaviors, protecting provider well-being, and improving clinical workflow.

Psychological Aspects of Dermatologic Care

Rieder began by noting that dermatology is commonly associated with psychological complexity. From anxiety over skin cancer risk to body image concerns in cosmetic dermatology, clinicians frequently manage patients’ emotional struggles without formal psychiatric training. As many patients are unaware of the mental health undercurrents driving their dermatologic complaints, “we have to sort of do some sort of ‘psychiatry in disguise,’” according to Reider.

Managing Talkative or Anxious Patients

One common scenario is the overly talkative or anxious patient. Rieder advised allowing patients to speak uninterrupted for 2 minutes, a tactic that fosters trust while limiting disruption. After that, clinicians can regain control by asking, “Can I ask you a few important questions now?” Using closed, yes or no questions can steer the visit productively. For more complex cases, he emphasized setting clear expectations early in the visit, limiting the scope to one main issue, and scheduling follow-ups for further evaluation.

Setting Boundaries and Preserving Provider Energy

Maintaining boundaries is vital in high-volume dermatology practices. Rieder encouraged providers to avoid oversharing on social media and to be cautious with “friends as patients.” Friendly patients can blur lines, especially in aesthetics, which increases medicolegal risks. Use secure apps if contact is necessary and avoid giving out personal phone numbers. When boundaries are crossed, consider behavioral contracts to formalize expectations.

Identifying and Referring Mental Health Conditions

For patients with delusional parasitosis or body dysmorphic disorder (BDD), direct psychiatric referral is often challenging.

"This is probably the most common question I get: how do I get someone to see a mental health provider?” Rieder said. “It's really, really hard. [It] just takes time, right? Maybe it’s not always going to work. So, you have to recognize your own limitations here... you have to recognize that for many of these patients, you will never be able to help them.”

Instead, Rieder recommended building rapport, offering off-label treatments, and slowly introducing the idea of talk therapy to reduce defensiveness and distress.

Leveraging Psychological Tools in Practice

Small interventions can improve patient comfort and reduce procedural anxiety. Rieder recommended in-office tools like vibratory devices (e.g., Buzzy ice packs), guided ASMR, breathing apps, and music during procedures.² These evidence-based, low-cost methods enhance the patient experience and increase overall satisfaction.

Red Flags and Final Thoughts

Rieder warned providers to be alert to patients overly concerned with minor flaws, especially when the distress doesn’t match clinical findings, which is an indicator of potential BDD. “Beware the patient who loses control and don’t take things personally,” he cautioned, referencing patients whose outside stressors can often manifest as in-clinic emotional outbursts.

Ultimately, Rieder's message was clear. Dermatology providers of all levels are regularly managing mental health issues, whether they recognize it or not. By adopting psychologically informed techniques, setting boundaries, and knowing when to refer, clinicians can improve both patient care and provider resilience.

Looking for more insights from industry leaders like Rieder? Check out our conference coverage page to stay in the loop with what’s new and improved in dermatology.

References

1. Rieder E. Top Psychologically Informed Tips to Maximize Practice Efficiency. Presentation at Fall Clinical PA/NP 2025 Conference; May 30-June 1, 2025; Orlando, Florida.

2. Yosipovitch G, Canchy L, Ferreira BR, et al. Integrative Treatment Approaches with Mind-Body Therapies in the Management of Atopic Dermatitis. J Clin Med. 2024;13(18):5368. Published 2024 Sep 11. doi:10.3390/jcm13185368