I completed my Dermatology Elective last Friday, July 20th. I really liked my elective. I chose this as my elective because I wanted to do something different. I enjoyed learning about Dermatology but I felt it was a weakness that could be used in primary care. I was working with a very popular and well-known Dermatologist, so I saw a great deal. There were people who came from all over the US to see him. The majority of the time I saw full body exams on patients, checking for atypical moles, potential skin cancers, and pre-skin cancers. I did see some very interesting rashes, systemic diseases, and a lot of acne. I was unable to actually see patients on my own because of his popularity, however, he was a great teacher and I learned a lot.
A common complaint I saw in the office is constant itch. These were the hardest patients to treat, especially if there were no visual findings like rash. Thankfully, we treated them all, and many times I heard the words “Doctor, you saved my life.” Itch is a horrible complaint to have and to live with. Itch can be constant, spontaneous, or occur during specific times. Any of the above can severely decrease a patient’s quality of life. Many have developed scars, some in cosmetic areas, because of this problem. The first step is to take away the insult to injury, if there is one. This is simple, if there is nothing there to scratch usually people do not pick. The next step is something obvious but hard to follow- if it itches don’t scratch it. This is a very cruel thing to say to a patient. It is impossible for a patient to not scratch even though they know they should not. Instead of saying this say, "If it really itches apply gentle pressure over the area for a few seconds, but do not use your finger nails." This relieves the itch but does not cause any trauma to the skin. Using this technique may allow time for the skin to heal and for the itch to go away. The last step was to give a patient some medication. Many of you are probably thinking, this is so simple, it is. However, many practitioners do not follow this and the problem persists or worsens.
Wednesdays were cosmetic days. Here patients would get Botox, fillers, etc. I think that a lot of people have a misconception about these products. I know this because when patients came in for a consultation they brought up these views. In Hollywood, these products tend to be over used and the individuals tend to look like they are from another planet. In the office I worked in, the Doctor emphasized that fillers and Botox should be done to make a person look fresher but still look like themselves. The common medical practice of start low and go-slow is key, do not overdo, always under do when it comes to cosmetics. You can always add more later. Many patients that came in for consultations were apprehensive, not vain. Each person left looking like himself or herself, just less worn down. Throughout the process we would give the patients a mirror to help alleviate any anxiety that they were being altered. We would mix lidocaine with some of the products to make the experience less painful. Comfort is key. There was not anyone who was not happy with the results. Radiesse, is the product we used the most often because it is a natural product that stimulates a person to continue to make their own collagen.
As it stands, I have 4 days until graduation! This means that the next patients I will be seeing will be my own. I am currently applying for jobs in Family Medicine, Pediatrics, and Dermatology. I hope that I get some bites. Please continue reading, I have been told that I am able to keep this blog. I will be the alumni PA blogger. I look forward to writing about job seeking, working as a PA, etc. Thank you to those who have continued to read my student blog, I can’t believe I have 4 more days of being a student.