I’m not much of a traveler. I like to see the world through the adventures of my patients.
This is especially nice in the winter, such as during school vacation week. Within the past 24 hours, I’ve gotten messages from patients in Hawaii, Arizona, and Orlando.
Writing from Hawaii, Melvin showed me a photo of a small white spot that appeared on the outer aspect of his arm. I couldn’t make much of it except to tell him that it doesn’t look like anything that warrants a 9-hour flight to show it to me, at least not until he gets back to town.
Later the same day, Hermione wrote from Arizona to tell me that her granddaughter is very concerned about a dark spot on her leg. The photo doesn’t look too impressive, but you never can tell with pigmented lesions, so I encouraged Hermione to show it to me when she returns to Boston next week.
Finally, Svetlana forwarded a photograph of a rash on her foot that she said had “just come yesterday.” This was the nicest case of cutaneous larva migrans that I’ve seen in quite some time, although I am fairly sure it has been there for more than a day. I tried not to sound too excited about her diagnosis, of course (“You’ve got the coolest parasite!”), and just suggested that she come in to see me on her return next week.
North, South, West. I’ve been all over, without leaving the chair facing my computer screen. (Nobody seems to have gotten a volcanic eruption in Iceland this year.) All this with no packing, no waiting in airports, no TSA lines. Who says traveling can’t be a pleasure?
Practice dermatology – see the world!
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Brian was delighted. The fungal infection on his calf, treated for weeks with a topical steroid that had produced only intolerable itch, was subsiding nicely with oral terbinafine and topical ketoconazole.
“Can I drink when I take this medicine?” he asked. “The Internet says I shouldn’t.”
“It’s only another week, Brian,” I said. “Best to hold off ‘till then.”
“Because I really needed a drink last week,” he said.
“Why was that?”
“I was on a vacation with my father.”
“I see.”
“It was my father and his 70-year-old girlfriend.”
“Oh.”
“We were at a nudist colony.”
“You know, Brian,” I said. “Just hearing about that makes me want a drink myself.”
Practice can take you places you never went, places you’ll never get to, places you never want to get to.
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Although I have patients fill out the usual consent form on oral isotretinoin, on which they promise to contact me if they become depressed, I rarely find anyone who does. Instead, people tend to become rather happy once their acne improves.
Since I’m not a psychiatrist, I try to do an amateur job of assessing mood when patients come in for their monthly follow-up. I pass on my technique for any of you might find it useful.
“Hello, Peter, are you having any problems?”
“No.”
“Do you get headaches?”
“No.”
“Nosebleeds?”
“No.”
“Any aches and pains in your muscles?”
“No.”
“Are you depressed?”
“No.”
“Are you always this negative?”
If the patient smiles while saying, “No,” you’re in good shape. If not, consider suggesting a therapist.
Better still, send the patient to the Caribbean. Then propose that you go come along yourself as a consultant, just to keep an eye on things.
And bring sunscreen. For the two of you.
Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His new book “Act Like a Doctor, Think Like a Patient” is now available at amazon.com and barnesandnoble.com. This is his second book. Write to him at dermnews@frontlinemedcom.com .
