Derm Rotation

I'm just about finished with a very short Derm rotation. My Preceptor leaves for France tomorrow morning around 11am. I've probably only been at the rotation for 6-7 days out of the scheduled two weeks. Both Mondays I had Boards tests, then my Preceptor was gone last Friday and he leaves early on Tuesdays.

Even so, I'm bored to tears with cosmetic dermatology. The only thing that is still interesting is the Scottsdale hotties that come for TBE (Total Body Exams) wearing thongs. Actually today we had a couple more medically interesting cases: a very mild Mycosis Fungoides; a Dermatofibromasarcoma case; severe Psoriasis; and a women with horrible cutaneous Sarcoid that may have new onset Ovarian Cancer due to the immunosuppressants used for the Sarcoid.

But most of the two weeks has been freezing stuff with NO2, burning stuff with one of three lazers or prescribing meds (typically antibiotics, steroids and Vit A derivatives for acne). Throw in a couple a Botox injections, a few chemical peels and several cyst removals and you have a complete picture.

We move very fast, seeing about eight patients per hour. My Preceptor is an old-timer with thirty years in dermatology including many papers and even textbooks chapters. But he at the point where bedside manner isn't his strong point: nor is teaching. The one thing he's determined I learn on this rotation, after I mentioned it, is how to differentiate Actinic Kerotosis from Seborrheic Keratosis (known as barnacles). He says he's still practicing because he enjoys it, but you get the feeling he just wants to work through all the days' patients as quickly as possible.

Don't get me wrong, Derm is a great lifestyle and if I had the opportunity it would be hard to pass up a good residency. They make a ton, do lots of procedures, have no call and work whatever hours they want. Plus there's lots of cool new drugs, lasers and procedures (Mohs surgery) they get to use. But the competition is ridiculous and I would get bored to tears in a year or two.

When it comes right down to it, the thongs are no match to the vanity of these patients spending huge sums to reduce wrinkles, freeze rough spots and burn out hyperpigmentation.