The Distrustful and Poorly Compliant Patient
Ms. Dickinson is a 56 year-old new patient presenting with severe scalp dermatitis and psoriasiform scaling, for which a tentative diagnosis of scalp psoriasis has been made. She reports trying several topical agents, each for a few days on six different occasions over a 3-month period, with inadequate control. The referring dermatologist, who called you prior to the patient visit, is concerned that her insufficient response to therapy has been a result of poor compliance. He notes that she typically resists his treatment recommendations, and on several occasions has made blanket statements indicating her distrust of medical professionals.