This week is my penultimate week in dermatology, and I think I am looking forward to the end of this rotation. While its fantastic for spending time relaxing and on other 'extra-curricular' activities, it seems very hands-off which can get boring at times. Despite this 'boring' feeling to the rotation, I still get to spend some time in clinics this week, where I work on translating the complex medical language the consultant uses for the patient, who has no idea what is going on. The lectures continue this week as well, though one in particular is much more exciting as the consultant who is giving it had taken a large amount of tramadol before for pain relief as he had recently had shoulder surgery. He was somewhat 'high' and pretty crazy for the duration of the lecture, making it a lot more fun (though I cannot say I learnt too much from it!)
As I said before, in one of the clinics I was it (remember we are expected to be very hands on in dermatology) the consultant was talking to the patient after I had taken their history, and quizzing me at the same time. Asking me my differential diagnoses (the list of problems it could be) I listed off a number of diseases such as solar keratosis, Bowen's and SCC. The problem the patient had presented with was a red scaly patch on the face. I chose to use phrases like 'SCC' when talking to the consultant as I didn't want to start talking about 'Squamous cell cancer' in front of the patient, which may upset them (the 'C' word) when it may not even be that. The consultant continued talking to me and the patient using the same phrases (Bowen's, SCC and so on), before leaving to prepare the minor procedures room to have a biopsy of the site taken. I had seen the look of confusion on the patient's face while the consultant was talking, so once he had left, I asked 'did you catch all of that'.
"What the F*** was he talking about" the middle aged woman replied, clearly a little worried about all those three letter abbreviations that were being slung around. Usually the dermatologists are very good at talking in 'normal speak' to the patients, saving their Latin and Greek names for us long suffering medical students. I assume that this had been different as I had started off with the abbreviations and pretentious-sounding-names myself, so perhaps the dermatologist had though I had already explained these to the patient. Fortunately, as a medical student we are in the privileged position of understanding a few of these complex words while still remembering that not everyone does, so I could try and explain what the dermatologist had been saying (or at least the parts that I had understood...). This went pretty well, even though I had to explain around the 'Cancer' issue where one of the main reasons for the biopsy was because we were checking that this was not some kind of skin cancer. Bowen's disease is basically a squamous cell carcinoma 'in situ', meaning it hasn't spread at all, even to different layers of the skin, and so is easily treated. Good practice for me to explain things to patients, but a far cry away from trying to break real 'bad news' to a patient, such a terminal diagnosis. I do wonder what it is like having to do that for the first time, but hopefully I will not have to try that for a long long time!
Dermatology is a collection of fancy Greek and Latin derived words. Take a guess at what a diagnosis of a "melanocytic nevus" on your skin would mean...
Throughout my rotation in the dermatology department, I have met and got on very well with a chap working as a health care assistant in his year after finishing school. Initially he wanted to do medicine, but didn't get the grades, so is working as an HCA for a year before starting a different undergraduate course (neuroscience). His intention is to study medicine after finishing this degree. Seeing as I am leaving the department after next week, I have given him my contact details and told him that if he needs any help in writing personal statements or anything then he should contact me, as I would be happy to help. He was really enthusiastic about medicine, and it seemed a shame that he couldn't study medicine now, needed to spend three years of his life doing a course he wasn't really interested in, and even after that was in no way guaranteed to get in. I suppose I am feeling lucky to be here this week, and perhaps even a little guilty that I could be working harder during this very laid back rotation.