Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 40-year-old woman is evaluated for a rash on her hands that has been present for 6 weeks. This rash comes and goes throughout the year and has been present for many years, but never as severe as it is now. She also experiences itchy skin on her body. She had eczema …
MKSAP: 40-year-old woman is evaluated for a rash
A medical student recently asked my advice on her decision to pursue a career in dermatology. It was about 25 years ago when my own parents encouraged me to pursue this specialty. What was their deal? Perhaps, they anticipated future developments in the field and were hoping for free Botox treatments? As readers know, I rejected the rarefied world of pustules and itchy skin rashes for the glamor of hemorrhoids, …
Should medical students consider lifestyle when choosing a specialty?
My patient suddenly leaned forward, swung her hair up, and began to push it this way and that, determined to find and show me the partitions that her hair made when rested in a new equilibrium.
It was a warm Thursday afternoon and we were in dermatology clinic. This 20-something young professional had come to have her scalp examined. She’d noticed a sudden increase in the quantity of hair follicles that …
Thinning hair, and a heavy soul
MedPage Today recently tackled a very controversial issue in medical practice. The piece explored the ongoing battle between dermatologists and allied health professionals (AHPs) over the performance of dermatologic procedures. As independent NPs and PAs begin to bill for more and more procedures (thus potentially talking revenue away from board certified dermatologists) specialists are beginning to argue that the AHPs are practicing beyond their scope of practice.
According to the Read more…
The health care turf battles: It’s time to work together
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old man is evaluated for a 3-month history of intermittent itching on the forearms. He describes the itch as deep, with a burning or tingling sensation. Scratching helps somewhat, but over-the-counter topical corticosteroids have not helped. Cooling the skin soothes the itch. He did not notice a rash until he started …
MKSAP: 59-year-old man with intermittent itching
“Ultraviolet bad.”
That was the core message that came out of the introduction this morning of the Surgeon General’s Call to Action to Prevent Skin Cancer at a meeting held at the National Press Club in Washington DC.
There were some other messages that now raise skin cancer awareness and prevention high on the public health awareness list, such as …
Today it’s time to say, “Ultraviolet bad”
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? …
After retirement, a visit to a dermatology office
I’m impressed by how much we struggle with seemingly simple health decisions when faced with sorting through too much information.
Buying sunscreen: It’s a simple task, right? Most of us do it every year about this time. And among actions we can take to reduce our risk of cancer in general and skin cancer specifically, this choice is fairly important.
So my colleague was surprised to hear this snippet of conversation as she contemplated …
Authorities overestimate patients’ health literacy
The Ellen DeGeneres Show has repeatedly put out a call for viewers to send in their funny sunburn pictures and stories. The following was posted on the website:
Summer is here and everyone is hitting the beach or pool. Just don’t forget the sunscreen! If you did, and you have the bad sunburn to prove it, we want to see the funny photos. Be sure to tell us the story behind …
Social media advocacy matters: The case of the Ellen DeGeneres Show
Fifteen years ago I got an unexpected invitation to write a column for a dermatology newspaper aimed at practicing clinicians. Because dermatology is a concrete field that lends itself to punning, I called the column “Under My Skin.”
Writing it monthly since then has given me a chance to take a humorous and sometimes cathartic look at the joys and woes of practice. It’s fun to do, and gratifying to hear …
Shared exasperation is cathartic
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 64-year-old man is evaluated in the emergency department for a rash that first developed 3 days ago and has rapidly spread to cover most of his body. His skin is painful. He has a history of mild psoriasis and asthma. His psoriasis has been well controlled with topical corticosteroids as needed. …
MKSAP: 64-year-old man with a rapidly spreading rash
A recent article in the New York Times highlighted the high costs associated with some types of subspecialty medical care, in particular dermatological procedures like Mohs surgery. Indeed, the patient profiled in the piece went for a minor procedure which, including facilities fees and questionable referrals to an anesthesiologist and plastic surgeon, generated billing that topped an unconscionable $25,000.
This piece led to the predictable Read more…
How financial implications influence medical decision making
Kayla wrote in:
Hello! I am curious what you think about essential oils. They have recently become incredibly popular in my community, but I am pretty skeptical because so much of the enthusiasm is coming from those who have signed up as ‘distributors’ with doTerra or Young Living (2 essential oil multi-level marketing companies.). The biggest concern I have is that these companies (and all these new distributors) recommend taking many …
Be suspicious of the marketing for essential oils
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An article published in the New York Times last weekend has been circulating widely on the Internet, and I feel that more than ever, physician voices are needed to reach the public and counter certain misconceptions put forth by the media.
The article, “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” charts the growth of specialist incomes in the past decade, using the case of a patient from Arkansas who had a …
Mohs surgery is vilified, physicians again fail to respond effectively
I spent 4 hours on New Year’s Eve sitting in the surgeon’s chair getting a skin cancer taken off my nose. Nothing about the experience fits the “benign” label so many professionals, including yours truly, have used: routine; easy to treat; nothing to worry about. Friends, after this experience, which left me looking like a tall, white-haired Rudolph the …
Skin cancers are never truly benign
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old man is evaluated for a 3- to 4-month history of diffuse, intractable itching involving most of the body. He uses emollients regularly. He cannot identify any precipitating causes. He was relatively healthy before the onset of the itch but now feels chronically fatigued. The itch is relentless. He has used …
MKSAP: 72-year-old man with diffuse, intractable itching
Nothing puts more fear into the heart of an internist than a dermatologic chief complaint. And for good reason: we have very little exposure to the breadth of the field. To us, all rashes seem to be maculopapular, all bumps are pustules … or was that nodules?
It’s not that we internists don’t care about the skin or don’t appreciate its complexity. Rather, we simply haven’t seen enough bumps, rashes, and …
Doctors should hone their abilities to recognize visual patterns
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for a recurrent pruritic rash on her hands. She works as a dental hygienist and notices that it improves when she goes on vacation. Topical corticosteroids alleviate the rash, but it quickly recurs.
On physical examination, she has scaling, erythematous patches on her dorsal hands, fingers, and wrists. She has …
MKSAP: 32-year-old woman is evaluated for a pruritic rash
As a light skinned, be-freckled woman with a history of pre-melanoma, I have been sternly instructed to keep my dermatologist on speed dial. Every six months I dutifully return to his office for inspection — nervously eyeing the biopsy tray as I sweat through my paper gown, legs dangling from a vinyl exam table.
In preparation for my most recent trip, I decided to be “an empowered patient” and …
3 products that your dermatologist won’t like
The man who had been seated in room 2 by the medical assistant had been seen 6 months previously for a small, pigmented lesion behind his left ear, which a punch biopsy subsequently proved to be malignant melanoma in situ. He was sent to the Mohs surgeon in the interim who carefully excised just as much skin as was absolutely necessary and …
Melanoma refuses to abide the laws of general civilization
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