Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

After retirement, a visit to a dermatology office

Miranda Fielding, MD
Physician
July 31, 2014
Share
Tweet
Share

I’ve always been good at pattern recognition and my visual-spatial orientation is excellent. Photography is my hobby, so it was only natural that as a medical student and internal medicine resident, I loved my dermatology electives.  Each day yielded up a new parade of interesting skin lesions and rashes, and by the end of my rotations I was confident in my diagnoses and recommendations. Contact dermatitis? Steroids!  Eczema? Steroids!  Psoriasis? Yep, you got it: steroids again!  Pimples?  Well that was a diagnosis that required antibiotics.  But sometimes, when it was really bad: yes, steroids!

These were the days before Botox, and Restylane, and non-invasive mini lifts, and lasers.  Occasionally there was the excitement of a skin cancer, or a truly serious life threatening dermatologic crisis, but as much as I enjoyed saying the words “pemphigus,” or even “bullous pemphigoid” (try it—they roll right off the tongue) — I didn’t want to spend my career looking at it.  I chose radiation oncology after my internal medicine residency, and never looked back.  I wanted to take care of sick people.

When I announced my retirement in February, the calls started coming in immediately.  Having moved several times since I graduated from medical school, I hold medical licenses in three states which makes me a prime candidate for companies who supply locum tenens or “hired hands”: doctors who cover practices while the regular doctor goes on vacation, takes maternity leave, or just needs a break.   I was vaguely interested, but not enough to commit to spending weeks away from home living in a hotel.

But then a call came in from my old group, a Los Angeles based practice that had just set up a skin cancer treatment unit in a San Diego dermatologist’s office.  The hours were reasonable, and the job was only two days a week, covering while the regular radiation oncologists took their summer vacations.  This type of radiation machine, called the Xoft, is fairly new and uses a miniaturized high dose rate x-ray source to apply radiation directly to the skin cancer, while minimizing the dose to surrounding tissues.  For basal cell and squamous cell skin cancers, the results are extremely good, with excellent cosmetic results providing a great alternative to the Moh’s procedure which can leave patients with a significant “divot” in their faces, sometimes requiring skin grafts.  Dermatologists can buy these machines, however they are not legally allowed to operate them, having no training or background in radiation therapy.  That’s where I come in.

For the last two weeks, I’ve spent Mondays and Wednesdays in the dermatologist’s office.  It is a remarkably busy office with seven exam rooms going at all times, an operating suite and numerous medical assistants scurrying around with headsets on to communicate with central command.  The atmosphere is similar to what I would imagine the air traffic control room is like at JFK.  No one ever goes to the bathroom or takes a lunch break. There are flat screen TV sets in every exam room, to entertain the patients while they wait. (Try explaining skin cancer treatment with radiation to an 86-year-old with bilateral hearing aids watching an episode of 24 — challenging to say the least!) As the physician in charge of radiation, I must set up each patient to make sure the applicator is placed correctly.  This involves a brisk walk down a long hallway from my makeshift office to the radiation room many times a day.

In the middle of that hallway, mounted on the ceiling, there is a television which runs a continuous infomercial about the joys of cosmetic dermatology.  It took me a few passes to notice it, but once I did, I was mesmerized.  The pulsatile blue light of the laser erasing wrinkles, the miniscule needles injecting the varicose veins, the tightening of the dewlap under the chin and the apparent dissolution of fatty deposits in the wrong places and their magical reappearance to plump the cheeks and add youth to the lips were hypnotic.  A head-setted medical assistant colliding with my ample in-need-of-liposuction derriere brought me back to reality and the skin cancer patient waiting.

I am beginning to see some advantages in my current part time job.  I smile brightly at the dermatologist in his scrubs.  He is an MD-PhD and very smart to have hired radiation oncologists to treat his skin cancer patients.  I have a new admiration for the tools of his trade.  I think that if I am really diligent, I might just get a free consultation and who knows — with a little buffing and polishing and injecting — a whole new face!

Miranda Fielding is a radiation oncologist who blogs at The Crab Diaries.

Prev

Correcting the physician shortage isn't an easy solution

July 31, 2014 Kevin 8
…
Next

Patient satisfaction has come full circle. Why you need to care.

July 31, 2014 Kevin 17
…

Tagged as: Dermatology, Oncology/Hematology

Post navigation

< Previous Post
Correcting the physician shortage isn't an easy solution
Next Post >
Patient satisfaction has come full circle. Why you need to care.

ADVERTISEMENT

More by Miranda Fielding, MD

  • I began to love medicine again

    Miranda Fielding, MD
  • What is the recipe for a great cancer doctor?

    Miranda Fielding, MD
  • Plastic surgery is more than Botox. Hopefully doctors can remember that.

    Miranda Fielding, MD

More in Physician

  • a desk with keyboard and ipad with the kevinmd logo

    How to advance workforce development through research mentorship and evidence-based management

    Olumuyiwa Bamgbade, MD
  • The truth about perfection and identity in health care

    Ryan Nadelson, MD
  • Civil discourse as a leadership competency: the case for curiosity in medicine

    All Levels Leadership
  • When a medical office sublease turns into a legal nightmare

    Ralph Messo, DO
  • Why the heart of medicine is more than science

    Ryan Nadelson, MD
  • How Ukrainian doctors kept diabetes care alive during the war

    Dr. Daryna Bahriy
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • How to advance workforce development through research mentorship and evidence-based management

      Olumuyiwa Bamgbade, MD | Physician
    • The truth about perfection and identity in health care

      Ryan Nadelson, MD | Physician
    • Civil discourse as a leadership competency: the case for curiosity in medicine

      All Levels Leadership | Physician
    • Healing beyond the surface: Why proper chronic wound care matters

      Alvin May, MD | Conditions
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Dear July intern: It’s normal to feel clueless—here’s what matters

      Tomi Mitchell, MD | Education

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • How to advance workforce development through research mentorship and evidence-based management

      Olumuyiwa Bamgbade, MD | Physician
    • The truth about perfection and identity in health care

      Ryan Nadelson, MD | Physician
    • Civil discourse as a leadership competency: the case for curiosity in medicine

      All Levels Leadership | Physician
    • Healing beyond the surface: Why proper chronic wound care matters

      Alvin May, MD | Conditions
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Dear July intern: It’s normal to feel clueless—here’s what matters

      Tomi Mitchell, MD | Education

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

After retirement, a visit to a dermatology office
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...