Dermatology is a funny, unusual specialty, and how I got here is unusual too. I realized this as soon as I started my residency. I had just finished my internal medicine residency of three years, and the contrast between the two specialties was jarring. I entered the quiet elevator and stepped foot into the elegant, carpeted spaces of the Dermatology Department. I knew it was going to be vastly different, but I didn’t realize how much so. Let me share some things you didn’t know about me, your dermatologist.
No longer was I dealing with the urgent, life-and-death situations of inpatient medicine. The atmosphere was calm and controlled, and very academic. Most jarring was that being on-call in dermatology was a cakewalk compared to being on-call as an internal medicine resident in the hospital. The biggest change was that I slept. I actually slept in my own bed in my own room in my own apartment when I was on-call for dermatology. Whaaat? That never happened in internal medicine. Not only did all of us internal medicine residents spend our nights in depressing, moldy, dark call rooms in the hospital, I usually got about 2-3 hours of sleep in a 36-hour period. And that was a good night because I actually got to sleep a little. Some nights allowed absolutely no sleep. Those were bad nights, and were not uncommon. Yes, I worked 36 hours straight when I was on-call. We all did. We started our workday the morning before, at the crack of dawn to make rounds. And then headed exhaustedly home the next day in the evening after we checked on all of our sick patients and signed off to the team on-call. And we would hit “play” and start it all over again the next morning, 10-12 hours later. We took call every three to four nights. If we had an every-two-night schedule, which was usually in the intensive care unit, it was “only” 24 hours, and then we got 12 hours off after. But let me say that 24 hours on the ICU is like doing 48 hours on the regular medical floors. The seemingly truncated call of 24 hours was not a favor.
I almost quit medicine half way through my internship year of residency. I hit an almost-breaking point while on my oncology rotation. All my patients had end-stage metastatic cancer. They were all dying. Being on-call in this rotation meant that several of my patients and patients on other services would die on my watch on-call. It wasn’t anything I was doing wrong; it simply was that nothing more could be done. They were at the end of their life, and I was the one to help them stay comfortable when it happened. I never, ever slept when I did call on this rotation. It was grueling. That’s just how it was. I couldn’t take it. I decided that medicine wasn’t worth it to me. I was deteriorating emotionally and physically a little every day myself, and I was willing to give up my 8½ years of education. I felt as if I had no more left in me to give anymore. Fortunately, many of the residency call requirements and regulations of the past have changed. That is a very good thing. And I don’t know why, but I didn’t quit being a doctor then. I guess the reason is that I am not a quitter. I didn’t give up. That is a good thing, too.
So, back to dermatology… I have touched upon why I love my specialty in past blog posts. I have shared this a bit with patients from time to time because many ask. So, why dermatology? I love dermatology primarily because it allows me to be the quintessential family doctor, albeit focusing on one organ system. I take care of every age from birth to death. I take care of women. I take care of men. I take care of babies, children, and adolescents. I take care of people in every stage of life. I have the privilege of continuity of care without the immense responsibility of medical emergencies. I am an internist one moment and a surgeon the next. I figure out things about the skin that no one else can. Sure, a primary care physician may have the ability to check a mole or treat a wart, but ask any physician patient who has had an itchy or painful rash, or a worrisome skin growth. They come to me, the specialist. I can diagnose, treat, and cure them, and these doctor patients are so very thankful.
I also love that skin is often a reflection or consequence of what is going on inside the body. (This part reveals the internist and research scientist in me. I did a lot of genomic, molecular biologic bench research during my training. Lots of us dermatologists did lab research.) Skin is more complicated than anyone knows or thinks. It requires me to be a skilled multi-tasker. It requires me to be a deep thinker, one that is always thinking outside the box. I learned that a good dermatologist needs to be pediatrician, geriatrician, internist, immunologist, microbiologist, histopathologist. epidemiologist and surgeon, all in one.
I also save lives, contrary to others who think I only do Botox and fillers all day. I diagnose melanoma on a regular basis, and when caught early, it can be cured. Skin cancer is not the only serious condition I treat. I treat numerous debilitating skin diseases, like lupus and psoriasis, as well. This part of my specialty is truly brilliant. I don’t need a special MRI or blood test to know that I have to biopsy a suspicious lesion or how to treat a worrisome rash on the skin. My eyes are my diagnostic tools, and I can save a life so simply.
Finally, dermatology allows me to be creative. Performing routine Botox and dermal fillers has fallen into the hands of many, like aestheticians, nurses, dentists, gynecologists, and family practitioners, but having the finesse and artistry to do them well and naturally is a different story. Plus, as a dermatologist, I really know the skin, and I can offer you treatments beyond the routine to improve the general health and vibrancy of your skin. Botox and fillers by skilled hands will take you a long way, but daily maintenance and prevention are essential to any anti-aging regimen. You can count on me to do the research for you to find the proven, state-of-the-art treatments out on the market. This is the nerd in me.
So, that’s me, your dermatologist in a nutshell, or through a discourse of sorts. Next week I will blog about the top 10 things you didn’t know about me as your dermatologist, things that I have touched a bit upon here and other quirky things about me that may peak your interest.
Read more about Dr. Linda Honet:Things You Didn’t Know About Your Dermatologist: Part I – The Story