Ambulatory Medicine
So currently I'm doing the mandatory RWJ senior medicine. Its all speciality clinic along with dermatology. And it is the absolute WORST class i have ever taken. If you combine poor organization with poor concept.. this class is what results.
So for all of you go-getters out there considering a career in derm: plz leave.
I hate dermatology. They know like 4 diseases: acne, ezcema, skin ca.. and .... well.. there must be something else. What a sad existence.. every 15 min.. doing a skin exam.. looking at some moles.. resecting them. Freeze something here, cut something there. If your lucky u get to inject paralysis toxin (botox) into people's faces.
So what I did i do the whole week.. well i can count the number of patients i saw on one hand. 2 derm patients.. surprise surprise one had acne the other had actinic keratoses (pre-squamous cell skin ca). What i dont understand, is that if THEY wanted us to learn derm, shouldn't they send us out on derm consult with the hospital. That way we'll learn derm as it relates to medical disease. (i.e. lupus, psoriasis, etc) and not this job which could be done by a nurse, and not someone who spent 4 years in medical school and 3-5 years in residency.
The other patients i saw during the week were actually very interesting. Two RA (Rheumatoid Arthritis) patients i saw during Rheum clinic. I had been dying to see RA during medicine, but never had any patients such afflicted. So one of the patients had lost the ability to mover her fingers, the joints were mostly destroyed, and she stil had active smoldering disease. She was actually pretty cool with the whole thing, which is surprising because she said she was quite athletic b4 the disease started. She going to try a new Il-6 antibody blocker, which is SOO coool.. the company is giving her a FREE supply for 5 year (thats like 15000 worth of IV infusion) if she participates in the trial. Im quite excited that we can stop progression of her disease, although there will be no regain of fxn. The other patient's disease wasnt as severe, but you could still see some obvious synovitis. She had some mild deformity in her 2-3 MCPs on her right hand, and didnt want any biologic agents (i.e. entarecpt/remicaide) at this time. Her ESR was still a little high on MTX and pred, i think it was like 60 so she had smoldering disease. But we couldn't convince her to go for it because she was scared of needles. The wierder part is that her SISTER was the first patient i saw. So she knows exactly how bad the disease can get! I hope she does well, but i'm a little concerned about the outcome. I wonder if there is anything that can be done for people scared of needles?
Like ativan or something? Maybe systematic desensitization? I dont know.. i dint want to suggest these things at this 15 min visit.
Im out
So for all of you go-getters out there considering a career in derm: plz leave.
I hate dermatology. They know like 4 diseases: acne, ezcema, skin ca.. and .... well.. there must be something else. What a sad existence.. every 15 min.. doing a skin exam.. looking at some moles.. resecting them. Freeze something here, cut something there. If your lucky u get to inject paralysis toxin (botox) into people's faces.
So what I did i do the whole week.. well i can count the number of patients i saw on one hand. 2 derm patients.. surprise surprise one had acne the other had actinic keratoses (pre-squamous cell skin ca). What i dont understand, is that if THEY wanted us to learn derm, shouldn't they send us out on derm consult with the hospital. That way we'll learn derm as it relates to medical disease. (i.e. lupus, psoriasis, etc) and not this job which could be done by a nurse, and not someone who spent 4 years in medical school and 3-5 years in residency.
The other patients i saw during the week were actually very interesting. Two RA (Rheumatoid Arthritis) patients i saw during Rheum clinic. I had been dying to see RA during medicine, but never had any patients such afflicted. So one of the patients had lost the ability to mover her fingers, the joints were mostly destroyed, and she stil had active smoldering disease. She was actually pretty cool with the whole thing, which is surprising because she said she was quite athletic b4 the disease started. She going to try a new Il-6 antibody blocker, which is SOO coool.. the company is giving her a FREE supply for 5 year (thats like 15000 worth of IV infusion) if she participates in the trial. Im quite excited that we can stop progression of her disease, although there will be no regain of fxn. The other patient's disease wasnt as severe, but you could still see some obvious synovitis. She had some mild deformity in her 2-3 MCPs on her right hand, and didnt want any biologic agents (i.e. entarecpt/remicaide) at this time. Her ESR was still a little high on MTX and pred, i think it was like 60 so she had smoldering disease. But we couldn't convince her to go for it because she was scared of needles. The wierder part is that her SISTER was the first patient i saw. So she knows exactly how bad the disease can get! I hope she does well, but i'm a little concerned about the outcome. I wonder if there is anything that can be done for people scared of needles?
Like ativan or something? Maybe systematic desensitization? I dont know.. i dint want to suggest these things at this 15 min visit.
Im out
posted by AKJ at
10:23 AM
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