Dermatology: expectation vs reality

I’m going to admit, dermatology wasn’t one of the placements I was looking forward to. I’m sure I wasn’t alone in this either. Luckily, after two weeks at dermatology, one can say I was very much positively surprised!

Here are some of my expectations from before the placement and my insights of the specialty after my two-week placement.

1. You see acne and eczema everyday

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On the contrary, most of the times it was a toomah.

During our two weeks there, I saw two acne patients and probably around five eczema patients. Skin cancer patients on the other hand? I definitely lost track. They came by the truckloads. Perhaps the reason why I thought dermatology = eczema and acne is because those are the only two skin problems I ever sought medical help for. Also, I’m brown. So what skin cancer?

2. Apart from acne and eczema, it’s all about too much sun

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So many patients come in with different skin lesions, many explained by too much sun exposure. However, when I was studying about the different diseases we saw at the hospital, I was surprised that it is so much more than that. This really became apparent for me when I was reading about psoriasis. I mean in this case, it is even the opposite.

Psoriasis is a skin condition which has a complex immunological pathogenesis – a lot more than just simple skin damage. It has been shown that sunlight has a therapeutic effect, improving the patients’ disease. Consequently, psoriasis patients in Sweden actually get offered a free three-week “therapeutic” vacation in the south of Europe. Not bad eh?

This is just one of the many skin conditions that is not because of sun damage.

3. There is a cream for everything

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Rash? Take this cream. Acne? Take this cream. Palmoplantar pustulosis? Take this cream.

Although there is some truth in this (yes, the main treatments for those conditions I mentioned are creams), it’s only a very, very small part of what dermatologists do to treat patients. Dermatologists also prescribe other forms of medication like injections and tablets, and also perform surgery of course – via liquid nitrogen “freezing” or excision! They also treat their patients in different baths and therapeutic light therapy, which is basically therapeutic solariums. Also, did you know that dermatologists in Sweden are  venerologists (STD-specialists) too? Yup, if there’s some funny business going on down below, you go to a skin doctor.

4. Most dermatologists are women

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When we came to the clinic during our first day, I was positively surprised that our supervisor was a very friendly and jolly male överläkare or consultant. There were actually a lot more male dermatologists than I thought, because he wasn’t the only one I met at the three hospitals I visited. At our main hospital there were at least three!

5. Most patients are vain

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My thinking before the placement: “Patients who come to dermatology are vain which is why they’re super self-conscious about their skin.” Boy was I wrong.

In cases of acne and eczema, I thought patients come in because they want to make themselves even prettier by treating the disease. I realised that they come in because they want to be pretty. Because they don’t think they are.

There is apparently a link between acne and negative mental well-being, and this I could definitely see from some of the patients I met. Many develop low self-esteem and even a form of dysmorphism, because of their skin problems. Definitely the opposite to what I thought in the beginning.

6. Dermatology is a “clean” specialty

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What I mean by clean is that there is no need for messy tubes here and there, sputum/faeces/sweat etc. samplings, no need to open patients up etc. The speciality relies mainly on the visual evaluation of a person’s condition. See, clean. Although it might be so most of the time, there are definitely exceptions.

During our first visit to the dermatology ward, we visited a patient with a rare but severe cutaneous vasculitis called pyoderma gangrenosum. If you’re curious, do google it, but be wary of what you will see. I warned you. Keep in mind though, the photos you will find on google are very, very far from what I saw. The patient we saw basically had no flesh all the way down to his tendons, on both feet extending above his ankle. Exactly like how you would see a fixed cadaver model of feet muscles for anatomy. But this time the specimen is alive. That is not what I would”clean” at all, and I don’t even want to start about the smell…

7. Skin lesions will no longer be dots for me after two weeks

Jokes nope, still dots.

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Dermatologists for the day

It’s coming to the end of our dermatology placement here in Jönköping and apparently as always, during this week they give us the opportunity to have our own clinic. It may just be me but I was slightly worried, but excited to have our own patients. I remember enjoying this when I got the opportunity in the UK. But this time it’s dermatology though. Do I know enough about skin?

My first patient came in and luckily he was a jolly man coming to check on a skin lesion on his head. After a few minutes of conversation, our doctor supervisor knocks on the door to take me out of the room for discussion together with my classmate, who also had his own patient. After the discussion, we decided to see my classmate’s patient first and then mine. However when we went to my patient, he was gone!

Great, my first own patient ever in Sweden vanished into thin air. Well that wasn’t a very good start now was it. (We called him later on and found out he didn’t leave because he was unhappy with the care but because he had an appointment to keep.)

Nevertheless, I had to put my worries aside and take my next patient in.

I let in my next patient who was a woman around my age with acne problems. I don’t know if it was because we were of similar age or that I also have had acne problems in the past, but we got along really well! She was telling me of the negative impact her acne has had on her mental well-being, and I definitely could relate. So I decided to give her the same self-care advice I was given which helped me with my acne – “off the record” of course. I told her I will now step out of my “doctor” role and now into my role as a girl helping another girl out.

Unfortunately, as I was giving her my acne care and makeup tips, the doctor came in to bring me out for discussion. Darn, I was in the middle of something I thought.

After discussing my classmate’s and my patients, we decided to see my classmate’s patient before mine once again, mainly because I asked for some time to speak with my patient some more afterwards. Then we came to see my patient.

We discussed at length with my patient regarding the etiology of acne and its treatment, which she greatly appreciated. We also discussed the negative impacts it has for my patient. At the end of the consultation we came to a treatment plan that both she and we were happy with. After this she said:

“At first annoyed that I had to come to the doctors this morning because it’s my birthday today. But now I feel that I’m getting something from you so I’m happy I came. It’s like a present for me, so thank you!”

Touched, we all said goodbye to her. As I said goodbye however I asked if she had more questions for me. She then asked me for more acne care and makeup tips, and I was happy that I could continue where I left off!

I told her the importance of moisturising (which I learnt from my sister), and informed her of the type of make up she should use and not use. I also quickly told her how I usually do my makeup to hide all the spots (perhaps a video tutorial in the future?). She was happy to hear my tips and told me she will buy the products I recommended. I was happy I could talk makeup in a medical setting. Afterwards, we happily said goodbye, and wished each other all the best. I greeted her happy birthday once again, and apologised that I missed that it was her birthday today from the medical journals.

Shame, shame, shame on me. But at least this time, this patient didn’t disappear!

As a doctor, my goal is for my patients to leave the clinic the same way that my second patient left – happy, and with the feeling that we did something that helped them. Even if it is on a day like their birthday. Who knew being a “beauty expert” was part of the job!

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Nässjö and jogging around the beautiful Rocksjön

Just like yesterday, I had to once again travel to a new city, new hospital in Nässjö. Once again, we were positively surprised at the hospitality of the people at the clinic.

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We were welcomed with an Easter buffet breakfast!

We came at about 9.30am, and was told to go upstairs to the kitchen. As we entered, we were greeted by the kind staff who invited us to the table. Apparently, they had set two plates for us at their Easter table since yesterday, anticipating us. Yup, I don’t think we could’ve felt even more welcome.

During the rest of the day, we were able to see the typical cases you’d see at every skin clinic: eczema, psoriasis, skin cancers etc. The staff there guided us to the rooms every time they knew there was an interesting case for us to see. We were going to end our day with scabies – which I read from our Swedish dermatology book is a typical Scandinavian skin infection – but on examination, it later turned out to be dry skin. I guess that’s both good and bad news. Nevertheless, it was yet another enriching day at dermatology!

When I came home, anticipating all the Easter food I’ll be eating in the next few days at home, I thought it would be a good time to go for a jog. It was pretty sunny too anyway. So I decided to run around the lake right in front of where we live called Rocksjön. I don’t know if I ever have had a more scenic run before because boy was it beautiful.

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If you look to the right I took some random running route to finish a 5k, because I noticed that someone was randomly following me… He luckily stopped running after me at some point. The red-ish spot by John Bauer’s park is where I took the photo below!

I have been extremely fortunate to have been placed at such a beautiful place, with such an amazing group of people. I can’t believe my first week at dermatology here in Jönköping is already about to end by tomorrow, time is going so quickly! I’ll make sure to cherish the time I have left next week. But first, here comes a long Easter weekend back home in Stockholm!

Rocksjön is absolutely stunning, a wharf by the lake

Could one really ask for a better evening jog?