Impressions of Dermatology

Shadowed Dr. S today. Dr. S is the chief resident of Derm in a tertiary care center who ultimately wants to enter academic medicine. Over four hours I watched him examine a patient for premature male-pattern baldness, do a couple of new patients intakes, do a few procedures like removal of moles and possible melanomas, and got at taste of what it was like to dictate, write up notes and interact with attending physicians. In contrast with cardiology consults the day before where we were standing up most of the time, here we were sitting down with patients in rooms. Unlike in the wards or the ICU, the patients were ambulatory, most did not have dire conditions and no one was in any real distress. Throughout our session, the dermatologists role was one of counselor and diagnostician. Although I did see several procedures, none were very involved nor complex. Most diagnoses in derm did not involve complex pathophysiology although several were not straightforward. As in my previous experience shadowing in the pain clinic in SF, I heard the word “crazy” used to refer to several patients which I did not like.

Overall, dermatology as a specialty seems to be characterized very much by choice rather than necessity from both the patient’s and the practitioner’s standpoint. Most patients that come into dermatology seem to have a choice of whether or not to go to a dermatologist. Hair loss, while traumatic, is not life threatening. The top three most common cases with the notable exception of skin cancer are acne, skin infections, mole removals, all non-life threatening. The physcian though is allowed a choice to some extent. Most dermatologists are in private practice (I was informed that DHMC actually does not keep any dermatologists on staff – too expensive) and have the choice to work more or less (make a lot of money or a lot more).

Yet the hours are great, the environment is generally upbeat, people are attractive and nice. I have yet to learn whether this difference between cardiology and derm is more due to the difference between outpatient and inpatient medicine or if the symptoms I saw were just specific to derm. What I take away from these two days of derm and cardiology is the lesson that shadowing experiences can be highly variable and that I should hold off judgement until I have seen a good sampling of interactions and get more direct experience in a field. Yet if I had to choose after today what I would be just based on what I have seen thus far, I’d choose to be a cardiologist.