Shortly after I began prescribing certain topical medications in the early 1990s, I started to question the ritual. That universal thrill new clinicians experience when confidently knowing the diagnosis and its treatment was soon tempered by the realization that many patients had arrived already knowing both, and they resented a system that required the time, effort and expense of a formal appointment solely to procure what they deemed an effective but harmless remedy that they would then have to circle back and retrieve at a pharmacy they passed on the way to my office. Who could blame them?