Skin Health
Dermatologist: How Do I Choose One?
alt
Share on FacebookTweet about this on TwitterGoogle+Pin on Pinterest
There are many qualified, excellent dermatologists in the world. But as is true in any profession, there are also a number who may not suit your needs. Some may not even be qualified to practice dermatology or may not have the training that you need for your specific concerns. And some may not be keeping up with the discoveries and innovations of the practice.

Much of the selection process is a matter of your personal preference. Do you want the best in the world? Want a great bedside manner? Need a specialist in your particular condition? These are the types of questions only you can answer.

But choosing a physician should never be about personal preference alone. There are important things to know that help you ensure you’re making the smartest decisions about the care of your body’s largest organ.



Why do I need a good dermatologist? It’s “just” skin, isn’t it?

6 Fundamental Rules on Selecting a Dermatologist

9 Questions To Ask About a Dermatologist

On Dermatologic Surgery

What Makes A Dermatologist?




WHY DO I NEED A GOOD DERMATOLOGIST? It’s “just” skin, isn’t it?

Think dermatologists are “just” Botox® and beauty? Think again. There is so much more that a dermatologist can do—bad (deformations from bad injectables, severe burns from lasers or peels, misdiagnoses) and good (saving lives).

Perhaps it’s because dermatologists are so good at making us look so good but we sometimes forget how serious, complex and vital dermatology can be.

Also, it may be that the skin is not thought of as a vital organ in the way that, say, the heart is. But from providing protection for our internal organs, being a barrier against infection, and regulating our temperature, to the anatomical and emotional significance of our sense of touch, and the skin’s ability to expand and contract as we do throughout our lives, the importance of of the skin’s role in our overall health cannot be treated lightly.

The skin is our largest organ and it is also arguably the most immediate, most visible monitoring system we have for the state of our internal systems. Way before internal organs manifest disorders in a blood test, ultrasound, x-ray, or MRI, dermatologists can recognize signs on the skin that may point to an internal problem. For instance, before blood sugar values are elevated, diabetes may show tiny distinctive scarred patches on the leg or small areas of numbness; a slow thyroid gland can be indicated by a form of skin thickening in various parts of the body; tiny red spots can signal inflammation of blood vessels both in the skin and in the body’s internal organs. Quite often, the skin serves as a direct indicator about what is happening inside us.

In addition to all the good that a great dermatologist can do, there’s a long list of “bad” that can result from poor care. Even “simple” procedures like injectables and lasers can go awry and when they do, the results can be difficult to correct and even dangerous.
There’s simply no downside to great physicians. They’ll do the “basic” stuff better and safer than anyone else. And they’ll be able to more quickly and ably notice, diagnose and treat serious problems should they occur.
It’s your skin. Don’t bargain on its care.

back to top


6 FUNDAMENTAL RULES ON SELECTING A DERMATOLOGIST

Rule #1: All Dermatologists Are Not Created Equal—Raise Your Expectations.

Just like any physician, dermatologists vary in terms of their fields of expertise, their education and training, their research orientation, and their bedside manner. You deserve a dermatologist that works best for you.

Raise your expectations. Because dermatology is such a popular field, strongly linked to aesthetics, and has mostly low-risk cases, the science can give the impression of being”soft”, just a step above cosmetology, and it can lower a patient’s expectations of care. But besides possibly lulling you to lower your standards in your selection process, in a medical practice, this high-volume, low-risk combination can create automaton-like doctors with an over-reliance on good ol’ reliables. Patients with similar-looking problems blur into one another, there’s a quick draw for a prescription pad (on which the same treatment is scribbled mindlessly for the hundredth time), and you’re herded away lickety split.

If a dermatologist isn’t careful, this rushed, cattle-wrangling approach can result in misdiagnoses, ineffective (or harmful) therapy, an aggravation of the problem, or the overlooking a more serious medical condition. To avoid these risks, raise your expectations of dermatology and your doctor.

Rule #2: Don’t be shy or uncomfortable about asking a doctor about her or his credentials.

You’ll be entrusting your skin to this physician and you have a right to know as much as possible about her/his training, expertise, and bedside manner.

A good, ethical dermatologist will respect your desire and right to find out as much about your physician’s professional credentials as you can, and won’t take offense at your questions.

Another plus: think of this is practice. It’s important that you get comfortable about asking your dermatologist anything. The more you ask, the more aware you’ll be of your skin and your treatment options.

Rule #3: Comfort and Expertise, a Happy Balance.

While you’re looking for a doctor with the best credentials for your needs, you probably also want someone who makes you feel comfortable.
Do you like the way this doctor makes you feel comfortable? Do you like how s/he deals with you? Does s/he freely share with you important information that you need to know? Does s/he seem open to your questions? Is the doctor patient enough with you when you’re confused about instructions or want more information. Does the doctor seem up-to-date on new developments?

While you want a doctor to not be too intimidating or downright mean (let’s face it, some are!), it’s still wiser to weigh expertise more heavily than a great personality.

Rule #4: Look For a Teacher-Student-Teacher-Student

Does your dermatologist teach? In order to train residents, a doctor needs to be up-to-date, which means your therapy is more likely to be current. Does s/he publish and/or lecture? Is your doctor a regular at important dermatology conventions?

Constant learning is often a good sign of a tirelessly inquisitive mind and this can make a big difference in the care you receive, from the most basic or purely esthetic to the most critical.

Rule #5: Look For True “Skinvestigators”

Does your doctor listen to your answers and delve into them? Or are your consultations dismissive and shallow? If a therapy isn’t working, does your doctor explore other possibilities, consulting with other specialists if need be? Does s/he doctor expand the interview to include questions about your lifestyle, work, general health? A doctor with a strong clinical eye for crucial details but who can broaden the investigation to explore other possible, non-dermatological conditions is a veritable gold mine.

Great doctors listen to you. You’ll be able to tell because they’ll be doing the following: a) recording your answers; b) asking you clarifying or follow-up questions; c) examining you under a light and/or a magnifier; d) answering your questions in detail; e) in follow-up visits, discussing your case with a resident (while this may feel uncomfortable, serving as an occasional subject for teaching should reassure you—it means that your doctor is expert enough in the subject of your skin to teach it.

Look for engagement: an investigatory doggedness that delves deep into your particular case. Is such involved care possible with busy doctors? All doctors are busy. The best ones are exceedingly so. But rushing through consultations isn’t necessarily a sign that a doctor is in demand. S/he could be starting out and need to see as many patients as possible to build up a practice. S/he could have lots of other commitments such as hospital administration or external business matters. Or the doctor could be in very high demand for quick esthetic services. No matter the case load, you should never feel like “just another patient”. Expect attention, probing and detailed questioning and analysis; expect delving deeper into your lifestyle and history.

Make no mistake: legitimate leaders in their fields are incessantly working, teaching, studying, writing, speaking, and attending conferences, and almost never have time for adequate sleep, their families, or drawn-out social chats with patients. But even in a practice so popular there are brawls in the waiting room, once in consultation, great dermatologists will make you feel like the only patient alive. No matter how busy they are, in consultation, the best doctors in the world fix their attention obdurately on you.

Choosing a doctor is fundamentally sleuthing for a sleuth. You want Sherlock Holmes in dermatologist form. Look for a doctor who is in love with medicine, who explores innovative treatment options, who studies, who teachers, who asks you a whole host of questions (not those just limited to your medical history) and who thinks like a super sleuth. Think Dr. House, but with way-better bedside manners. Believe it or not, truly great physicians enjoy the involved relationship with you almost as much as watching you get better.

Rule #6: Look for a Systemic-Minded Physician, Not A Quick-Fix Artist

If your dermatologist’s examination is cursory, with few questions, and you’re quickly given prescriptions for medications, treatments and costly procedures, pause.

Any physician who cares for you should care about your diet and exercise, cholesterol levels and other important markers, your stress levels, sleep patterns, hereditary illness, medical history, drug allergies and other aspects of your overall health. Your dermatologist is no exception. Your consultation should cover at least these bases and, if there are red flags, should include a prescription for addressing them or a referral to another specialist.

The best dermatologists will emphasize that they can only do so much in their clinics. You need to do your homework, too. Your skin is a reflection of the health of your internal systems. They will encourage you to improve areas of your health that need it, emphasize the importance of prevention in skin care, foods, etc., and require a consult if they suspect that you might have another condition that needs attention.

back to top


9 QUESTIONS TO ASK ABOUT A DERMATOLOGIST

Question 1—Properly Boarded?

Each country usually has one dermatological association that is internationally recognized. Is the doctor boarded with that official dermatological society or association?

Many countries require further certifications and licenses. You can contact your country’s dermatological society and ask what are the requirements for a physician to practice dermatology in your state or country.

Question 2—Can You Get a Copy of the Doctor’s CV (curriculum vitae or resumé)?

You should know enough about your doctors’ education and training. When perusing the CV:

  • Take note of the doctor’s medical school. Some schools are internationally recognized as stellar medical schools. If you are unfamiliar with the school, this doesn’t necessarily mean that it is not a reputable institution. Ask around to see how the school is generally thought of. Or, go online and do a search for medical school rankings or reviews. Also keep in mind that a doctor who went to a mediocre medical school could have completed prestigious residency and fellowship programs, or could be a well-published researcher or a well-respected teacher. The medical school is only a small part of a dermatologist’s credentials.
  • Pay attention to the doctor’s residency program. Again, is the residency program one that is highly regarded? Was it in a reputable hospital or university? Keep in mind that most dermatological residency programs are 3-consecutive-year programs. A dermatologist should have completed the 3-year residency in the same program. While different countries have different regulations, a doctor who does one year of residency in one program, and spends the next year or two of residency at another program, may not be considered as having truly graduated from a full dermatological residency program.
  • Note any subspecialty fellowships that your doctor may have completed. Did s/he do a fellowship in dermatopathology, pediatric dermatology or surgery? Did s/he study under a particular physician? If so, try doing a search online about your doctor’s mentor.
  • Are there any published papers or posters presented? If so, in which publications and conventions? Not all doctors are interested in publishing, but publishing is often a strong indication of a physician’s commitment to keep learning and pushing their field forward.
  • Another simple tip: is the doctor’s office riddled with books and current dermatological journals? Are there some current journals on her/his desk? This could imply that your doctor is interested in staying up-to-date with new developments in dermatology.
  • Does the doctor teach at a university or residency program? A teaching physician has to stay up to date with the latest technologies and has to understand the field well enough to train others. Furthermore, teaching physicians learn from the questions and challenges of their residents. And doctors who practice in teaching hospitals have access to resources such as innovative medicines and technology that can benefit you.
  • Has s/he held any positions in legitimate dermatological organizations? Does s/he regularly speak or lecture in medical or dermatological forums? Such involvement can indicate that the physician is held in high regard by her/his peers.

Do an internet search on the doctor her/himself for more information.

Question 3: Does the physician regularly attend dermatological conferences?

Attendance at important local and international dermatological conferences is important because these conventions augment the physician’s learning. Many important discoveries and developments are presented at these meetings. They have lectures, presentations, and workshops on some of the newest developments in skin diseases and treatments.

Some important meetings are the American Academy of Dermatology, American Contact Dermatitis Society, and World Congress of
Dermatology meetings. Local meetings are as important for learning that is specific to skin conditions that might be more prevalent in your country.

You want a doctor who’s up-to-speed on the field’s newest and most important developments as you’ll have a better chance of getting care based on the most current and proven technology, research, medicines, and data.

Question 4: What Are Your Doctor’s Specialties?

Make sure to ask if the doctor considers your particular skin concern one of her/his specialties.

Question 5: What Procedures Has Your Doctor Been Trained In?

Lasers? IPL? Botox® or similar therapies? Liposuction?

If you intend to pursue liposuction with a dermatologist:

  • Ask how many liposuctions s/he has done and what the results were.
  • Ask about where the liposuction will be done. Make sure that the procedure is done in a hospital, or within immediate proximity to a hospital with full trauma/emergency and operating room facilities.

While a fairly straightforward procedure, liposuction is surgery and while rare, serious complications that are best addressed in a full-service emergency room can occur.

Chemical Peels? If you do intend to get a peel, make sure:

  • That your doctor does not give you a pre-packaged preparation with only one dose designed for each patient. Chemical peels can be excellent treatments. But the dosage must be very carefully administered—the doctor must judge what concentration of the peel to use for you.
  • That the peel will be done by the doctor or by a dermatologically-trained, registered nurse or licensed esthetician within the clinic itself. Peels should not be self-administered at home.

If not properly monitored or administered, peels can result in serious burns and severe post-inflammatory hyperpigmentation (dark blotches that are very hard to reverse).

Question 6: Does The Doctor Offer (or Regularly Order) Patch Tests? Photo-Patch Tests? Biopsies?

These tests are excellent tools to determine what ingredients and other substances cause you allergies, irritations or darkening. Ask if investigative exams like those mentioned above are regularly done in the clinic—some doctors diagnose without diagnostic tests which can result in incorrect diagnoses and ineffective or harmful treatment.

Question 7: Does the Doctor Have a Support Team?

Does the doctor perform the procedures? Does s/he have dermatologically-trained, registered nurses or other licensed and qualified assistants to help with procedures? Does s/he have dermatology residents or fellows on site to assist with or perform procedures?

Question 8: Does the Doctor Have a Hospital Affiliation?

If your skin problem becomes complicated, or proves to be a symptom of another illness, would the doctor have ready access to a network of physicians who can work together to help you? If you need to be hospitalized, will the doctor be able to treat you at your hospital?

Question 9: Can You Ask For References?

Ask other doctors (in the same field or in other fields) if they know the doctor. The most ethical doctors will answer you honestly, even if they are in the same field. If they are not in the same field, they would base their answer on whether or not they would ask the dermatologist you’re considering to consult with her/him in case you developed a skin condition in their care (the question is: would you refer me to this doctor if you needed a dermatological consult for me?).

Ask friends or colleagues if they’ve heard of the dermatologist. People are usually quite honest about whether or not they would recommend their dermatologist.

back to top


ON DERMATOLOGIC SURGERY

  • Surgery is usually part of the 3-year residency program of dermatology.
  • Dermatologic surgery involves minor procedures to remove moles, cysts, warts, other benign growths, skin cancers, or procedures to improve scars. Advanced surgical training can be obtained for new, more complex procedures such as MOHS surgery for skin cancer.
  • Cosmetic dermatologic surgery includes liposuction, peels, hair transplant, minimal facial rejuvenation through Botox®, fat transplants, fillers like Restylane®.
  • Graduates interested in training further in these and other procedural branches of dermatology, including lasers and IPL, often go to leading hospitals to study with the medical masters of the craft.
  • To become a cosmetic surgeon, one must first be a general surgeon, to learn the basics of surgery. After the basics, the surgeon can specialize further by focusing on cosmetic procedures.

back to top


WHAT MAKES A DERMATOLOGIST?

Different countries have different requirements for dermatology. The following basic requirements are common to many countries. To confirm the requirements in your country, contact your local dermatological association (the governing board of dermatology in your country).

Requirement #1: A dermatologist must first be a physician. The individual must have graduated from an approved medical school, and passed the appropriate medical exams.

Requirement #2: A dermatologist must have successfully completed a minimum of 3 consecutive years of residency training in general dermatology in the same residency program.

After finishing this basic training, the physician can now be called a dermatologist. Patients can have the confidence that this physician has the basic knowledge required to practice dermatology. Furthermore, it is during residency that young dermatologists become members (at the collegiate or student level) of various dermatological associations. As such, they provide each other with the necessary checks and balances on the ethics and competence that governs their membership.

During this time, they submit their work to other physicians and dermatological peers (at meetings and lectures) to get feedback on what they’re doing and how they’re doing it. This is how dermatologists are validated by those most qualified to do so. It is ideal if your doctor completed her/his 3-year residency consecutively in the same residency program.

Requirement #3: Becoming a Diplomate. The next step is for the dermatologist to take her/his country’s board exams in dermatology. Passing these exams makes the dermatologist a diplomate. Only graduates of 3-year residency programs are eligible to take these exams.

back to top