The Art and Science of Dermatology
Presented: July 19 and 20th
Waterville and Augusta, Maine
David J. Elpern, M.D.
12 Meadow Street, Williamstown MA 01267
email: djelpern@gmail.com
URL: http://www.davidelpern.com
Grand Rounds is a time-honored institution. In 1978, Franz Ingelfinger, then the editor of the New England Journal of Medicine wrote a brilliant Sounding Board piece entitled the "Graying of Grand Rounds." I post it here for any who are interested to read it. Download ingelfinger_graying.pdf
The following is intended as a guide for primary care residents to validate and facilitate their handling of most cutaneous disorders.
Continuing Medical Education (as typified by didactic lectures) may entertain physicians and trainees, but has no impact on performance.
See Zeiger: Continuous Medical Education Download zeiger_cme.pdf
Unacceptably Long Waits for Dermatology Appointment
See: Download Resneck.pdf
Research has shown that PCPs perform poorly on diagnosis of skin disease:
I think the training need not be didactic, since didactic lectures have been shown not to be effective. But can be case-specific. Over three years, one can get a working knowledge of cutaneous disease one patient at a time.
The best part of the top 20 Skin Disorders seen in primary care can be handled by F.P.s
Resources to Aid in Dx and Rx
of Skin Disorders
- Dermnet: The Mother of All Derm Sites
- eMedicine: Free Updated Online Derm Text
- Clinical Knowledge Summaries from the NIH
Image Banks:
I think Dermnet is the best (see above)
Others:
- DermIS has thousands of images
- Global Skin Atlas
- Dermatology Image Database: University of Iowa
- DermAtlas.org
Web Sites and Blogs
We all work together
Illustrative Cases:
Procedures F.P.s should be comfortable with:
- Punch Biopsy
- Shave Biopsy
- KOH Prep
- Tzanck Prep
- Simple excisions
Punch Biopsy
3 and 4 mm punches
Needle holder
Scissors
Forceps (optional)
4-0 and 5-0 nylon sutures
Gauze
Non-sterile gloves
Shave Biopsy
Xylocalne 1% with epi
1 cc syringe + 30 guage needle for infiltration
1/2 of a "Blue Blade" razor
Guaze
Aluminum Chloride for hemostasis
Hyfrecator (Electrosurgery - Coagulator)
This is one of many models you can choose from.
Because of the long waits for consultation, if you take the time you can make most diagnoses. This is not quantum mechanics. You can be the doctor who is there:
On Skin Cancer and Screening
New York Times, July 10, 2007
Doctors Balk at Cancer Ad, Citing Lack of Evidence
By CHRISTIE ASCHWANDEN
Some doctors are questioning a cancer society ad campaign on sunscreen because most skin cancer is not life-threatening.
The Thesis
Cancers follow three basic patterns: turtles, birds and bears.
1. Turtles move so slowly that you can still capture them while they’re moving slowly along;
2. The birds fly away so quickly that you can’t catch them in time;
3. The bears can escape if you ignore them, but if you catch them in time, you can capture them.
For the full article go to Permalink.
If, at any time, you want to submit a case for suggestions to VGRD or VGRD 2.0, please follow this format:
- History
- Physical Exam
- Clinical Photo (please save and send as a small jpeg file)
- Lab Tests and Biopsies if done
- Specific Questions
What else would you like to know?
Contact me at any time: David J Elpern
