Consultations in Dermatology

You have your whole day filled with removals and restorations, to say nothing of documentation and administration. Why become a Sherlock Holmes investigating the crimes committed in your patient's skin? Here's why:

Skin sleuthing is fun. Solving a patient's problem makes for a better day, perhaps not financially, but intellectually. It may take weeks, but the delight of satisfying your curiosity for the benefit of your patient is great. It is not enough to repair a wrecked car. You must know why there was a wreck.

Solving problems, explaining the inexplicable, is a higher order of achievement than making diagnoses. And, bear in mind, your patient is much less interested in the “what” of dermatology than the “why,” but really wants to know both.

So, you want to be a Dermatologic Sherlock Holmes. It is not enough to don a deerstalker cap and smoke a curved pipe. You must acquire skills in these four areas:

THE HISTORY

Because many dermatologic diagnoses are simply labels for reaction patterns, it is up to you to look beyond the diagnosis and look for the cause. This is done best with a sharply focused history directed at probable or possible causes. All this calls for knowledge that comes from experience, from reading the literature, and above all, asking the patient what he or she feels is the cause.

We recall a patient at the University of Minnesota who presented with a swollen painful tongue.