A Day in the Life: Dermatology

7:15 am - alarm goes off. This rotation I get to "sleep in" most days because clinic starts around 9:15/9:30/10 depending on the day except Wednesday when we started at 7am.

7:30 am - finally roll out of bed. I do my usual morning routine of cleaning up, having my coffee and getting ready for work.

8:30 am - Drive to clinic. This rotation was in downtown Nashville so I always left a little early due to rush hour traffic.

9:00 am - morning clinic starts. Today we have two PAs and a NP working with the doctor. I usually go in to every room the doc goes to unless patients checked on their sign in papers that they don't want a student in the room. Things work very differently at this clinic. For each patient, we all go into the room as group - doc, a mid level, as nurse, and me (we are quite the crowd). Some patients get overwhelmed but most are used to it because they have been coming here for many years.

This morning we see patients for their yearly check for AKs (actinic keratosis), follow up for basal/squamous cell carcinomas (cancer) that have already been treated, eczema, seborrheic dermatitis, acne, dermatosis papulosa nigra (DPNs), sebaceous cysts, psoriasis, and rhus dermatitis (poison ivy). We do a couple of treatments for biopsies that came back as positive for BCC or SCC with curettage and electrodessication that I get to assist with. I also get to assist with I&D of the sebaceous cyst and perform cryosurgery (freezing with liquid nitrogen) on the AKs (pre-cancerous lesions that can turn into squamous cell carcinoma).

I also help bring patients back to a room and do a very quick HPI and update their chart because not only are we short staffed with nurses but it is also a good practice for me to do my own HPI and see a patient from start to finish. This is a very high volume clinic and just in the morning today we see close to 30 patients.

1:00 - 2:00 pm - lunch break. Today we had a drug rep bring us lunch from Chuy's and I definitely overate. This rotation I feel like I have barely meal prepped because we get lunch almost every full day that we work (3 days a week) and I just finish my leftovers on Wednesdays or Fridays.

2: 00 - 6:00 pm - see afternoon patients. We have another patient with a cyst that needs to be removed and I assist once again. I freeze off more AKs and SKs (seborrheic keratosis - begin lesions that don't turn into cancer and can be left alone unless bothersome to patient). More acne follow ups, more biopsies for suspicious lesions, alopecia areata (hair loss in a specific round pattern) and we even see a case of scabies incognito! I have been so paranoid this entire rotation that I'm going to end up getting scabies or warts. We didn't actually see a scabies mite under the microscope but treated the patient for it anyway because of how classic the presentation was (so classic that even I had that on the top of my differential).

We also see a patient for a follow up appointment with a rash that has been sticking around for months now that we want to biopsy. For reasons of patient privacy and HIPPA I can't disclose any more information but it's safe to say that was the puzzling case of the day for all of us in the office. What makes me sad when rotations come to an end is that I don't get to see the same patients again and see if everything turned out to be okay for them. It's just a part of this journey as a student but hard nevertheless.

Today is my last day of rotation so I stay a bit longer and talk to my preceptor and the PAs in the office about my time there and asked them if they had any feedback for me.

6:15 pm - rush home to take a shower and study for the EOR exam tomorrow. We have three multiple choice exams this week and one OSCE which we are all so stressed about.

7:00 pm - 10:30 pm - study, study, study. I finally call it quits and go to bed so I can rest my brain for the crazy testing schedule that ensues tomorrow.

Other conditions seen on this rotation: rosacea, viral warts, molluscum contagiousum, trichotillomania, alopecia universalis, sebaceous hyperplasia, angiomas, lentigo, nevi, psoriasis, systemic lupus erythematous, discoid lupus, disseminated porokeratosis, pityriasis rosea, pityriasis alba, dermatofibroma,  and more things that I'm sure I'm forgetting.

Procedures performed on this rotation: punch and shave biopsies (both all on my own :) start to finish), suturing for excisions biopsies, intra-lesional injections, electrodessication, and cryosurgery.

Day in review

Hours worked: 8

Total patients seen: 53

Patients seen on my own: 0

Hours studied: 3

previous days in the life
Family medicine
Internal medicine
Surgery
Psychiatry
Emergency Medicine

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