Dermatology practice often involves unique risk managementchallenges. Understanding these risk factors and the strategies to mitigatethem can help dermatologists deliver optimal care while reducing professionalliability exposure.

Pathology follow up and specimen management

Ensuring that pathology results are received, reviewed, andcommunicated to patients in a timely manner is essential. The foundation ofeffective pathology management is a tracking system that follows specimens fromwhen they’re taken until the patient has been notified of results. Thisrequires developing protocols to ensure specimens are labeled and storedappropriately, using EHR flags or tickler systems to track pending results,assigning staff members to monitor outstanding reports, and establishing cleartimeframes for when results should be expected.

Practice protocols should specify how results will bereported to patients, whether by phone call, letter, or patient portal message.Critical or unexpected findings demand urgent attention, and practices shouldconsider requiring dual verification before communicating high-riskresults.

Document patient notification in the medical record with thedate, method, and content of the discussion. Weekly audits of pending reportscan help catch any that may have fallen through the cracks.

Patient engagement is equally important. Patients shouldunderstand at the time of biopsy when to expect results and how they’ll becontacted. Encourage patients to call or send a message through the portal ifthey have not heard within the expected timeframe.

Scheduling and follow-up

Patients lost to follow-up represent a significant liabilityrisk. While EHR reminder systems can flag patients due for follow up, staff canalso be assigned to monitor compliance and reach out to patients. Protocolsshould specify different approaches for scenarios such as post-procedurechecks, routine surveillance, or chronic condition management.

A proven approach is scheduling follow-up appointmentsbefore patients leave the office, accompanied by clear written instructionsabout timing and purpose. Automated appointment reminders via text, email, orphone reduce no-shows, while priority scheduling ensures urgent follow up canbe accommodated quickly.

Documentation that’s specific — such as noting “returnin 3 months for skin check” rather than simply “follow up” — makes expectationsclear. When patients miss critical appointments and fail to respond to routinecontact, it may be necessary to send a certified letter to document attempts toprovide care.

Photography and image documentation

While clinical photography serves important diagnostic anddocumentation purposes, it requires careful attention to privacy and consent.Written consent should specify all intended uses of photographs, with separateconsent required for clinical documentation versus teaching or promotion. Anyuse beyond the original scope requires re-consent, and consent documentationshould be clearly noted in the medical record. ¹

Technical standards help to ensure images are clinicallyuseful. These standards can include consistent protocols for distance,lighting, and angles; inclusion of anatomical landmarks and measurement markerswhen appropriate; and capturing both contextual and close-up views of lesions.Use file naming conventions to help protect patient identity.

Privacy protection is paramount. HIPAA regulations statethat images must be stored in encrypted systems, with access limited toauthorized personnel. Clinical images should never reside on personal devicesor unsecured cloud storage. When images are used for teaching or promotion,identifying features should be removed. ¹

Medication safety

Dermatologists prescribe medications with significant risks,from isotretinoin to immunosuppressants, making medication safety systemsessential. Electronic prescribing with drug interaction checking and allergyalerts can catch potential errors before they reach patients. Maintainingaccurate medication lists and conducting reconciliation at each visit ensuresprescribing decisions are based on complete information.

High-risk medications require standardized monitoringprotocols. For isotretinoin, methotrexate, biologics, and other potenttherapies, checklists ensure required baseline and follow-up testing occurs.(2) Patient education should include risks, side effects, monitoringrequirements, and pregnancy prevention for teratogenic drugs. Teach-backmethods can help confirm that patients understand the risks and benefits oftheir medications.

Cosmetic procedures

Patients seeking cosmetic procedures may have heightened oreven unrealistic expectations of what can be achieved by their dermatologist.Because the cost of these therapies is often born solely by the patient, theremay be less tolerance for anything that does not go as planned. Anycomplication may be met with a higher degree of anxiety, anger, ordisappointment. Therefore, it is helpful to discuss realistic outcomes whenobtaining informed consent.

During this discussion, emphasize that every patient’sexperience and outcome will be their own. Ensure that the patient understandsthat follow-up procedures or new therapies may be necessary to achieve thepatient’s long-term goals or to address potential complications. ²

A thorough informed consent discussion can help lessenanxiety, increase trust, and improve understanding if a complication occurs.Several studies have shown that patients are less likely to file a claimagainst a physician with whom “they have developed a trusting and mutuallyrespectful relationship . . . even when patients have experienced considerableinjury as a result of a ‘medical mistake’ or misjudgment.” ²

Sources

1. Henry K. Guidelines for     medical photography under HIPAA. Accountable HQ. August 17, 2025.     Available at https://www.accountablehq.com/post/guidelines-for-medical-photography-under-hipaa. Accessed March 2, 2026.

2. Mayo Clinic. Cosmetic     surgery. June 21, 2024. Available at https://www.mayoclinic.org/tests-procedures/cosmetic-surgery/about/pac-20385138. Accessed March 19, 2026.

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