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Non-Dermatologist “skin specialists” – Dr. Lubitz explains the alarming trend

Non-Dermatologist “Skin Specialists” – Dr. Paul Lubitz Explains the Concerning Trend.

If you ask most people in Canmore, and indeed if you ask most Canadians, whether or not their skin’s health is important to them, chances are the majority will say that “Yes, my skin and its health is incredibly important.” And this is justifiably so. One’s skin is the largest organ in the body; the skin is what protects a person from bacteria and other germs; provides a physical barrier to the harsh and toxic outside physical environment, regulates a body’s internal temperature, and plays a critical role in a host of chemical processes that the internal organs of the body require for normal functioning.

So, yes, many people are aware of just how important their skin is, and moreover, many people in Canmore are aware of how important it is that they protect their skin from the particularly intense UV levels in our area’s high elevation.

All of which makes a couple of particular trends happening in Canmore and in other areas of Alberta and Canada all the more alarming and concerning.

The first very concerning trend that has been noted by practicing dermatologists and other physicians nationwide is that many Canadians are choosing to see non-dermatologist, non-physicians for important skin care needs. Most surprisingly is that this does not just include seeking straight forward advice for skin products such as moisturizers, toners, and sunscreens, or relatively simple skin concerns like dry skin but also for the diagnosis and treatment of many potentially serious medical, surgical and cosmetic skin conditions and concerns.

Estheticians, beauty department employees, drug store employees, pharmacists, nurses, other para-medical personnel, and even dentists, rank among the growing group of professionals and non-professionals who are touting themselves to be “skin specialists” and are offering skin-related services including advice on skin products, in addition to the diagnosis and treatments for a host of medical problems, including acne, eczema, psoriasis, warts, sun damage, moles and even precancer and skin cancer lesions. People are also increasingly seeing these non-dermatologist, non-physicians for skin-related surgical and cosmetic concerns and procedures that include a variety of laser treatments, neuromodulators, fillers and in some cases more advanced cosmetic surgery; treatments that require an in depth knowledge of chemistry, physics, skin anatomy and physiology, and advanced procedural skills working with and operating on the skin; not to mention a regulatory body to govern the training and competence of the practitioners providing these services in order for these procedures to be done correctly, effectively and most importantly, safely.

I myself have seen the tragic consequences of this increasing trend many times: a patient is misguided, misdiagnosed, or mistreated after following the erroneous advice of a non-dermatologist, non-physician quasi skin specialist. The results turn out badly; perhaps simply a delayed diagnosis that now requires more treatment than if it had been caught earlier; often there is a much more complicated treatment ultimately required to repair the damage of the inappropriate treatment previously suggested, and not uncommon is permanent scarring, long term emotional damage including loss of self esteem and confidence, and dramatically increased cost for the patient. Then the problem gets worse. The patient not only incorrectly assumed that the person that they were seeing for their skin concerns had the medical education, clinical skills, or technical knowledge required to responsibly provide that advice / procedure (which they don’t). But then the patient finds out that, in most cases, there is no governing body that regulates the conduct of that individual who has proposed to be a “’skin specialist”. There is no recourse for the patient, who is left frightened, frustrated and disillusioned.

The second very concerning trend today is the use of the title of “skin specialist” by non-dermatologist physicians. The Royal College of Physicians and Surgeons of Canada clearly identifies the Dermatologist (one who has successfully completed an accredited Residency in Dermatology) as the only Royal College accredited skin specialist. Such a specialist physician will have the letters FRCPC after their name, and be registered as a dermatologist with the Royal College of Canada as well as with the College of Physicians and Surgeons of Alberta (or any province). The use of the title “Skin Specialist” by non–dermatologist physicians is not permitted and can easily give the patient the erroneous perception that the treating physician is a dermatologist when in fact they are not. The training to be become an accredited dermatologist is long, difficult and arduous and lasts a minimum of 5 years after medical school, with the result that the medical knowledge, clinical acumen and procedural skills of a Royal College accredited dermatologist cannot be learned by attending weekend courses, conferences, or on-line tutorials no matter how many are completed.

Patients are encouraged to confirm and demand that the “skin specialist” physician they are seeing for their skin concerns is in fact an accredited dermatologist. In the province of Alberta, patients can find this information by looking on the website of the College of Physicians and Surgeons of Alberta. Copy and paste the following link: http://www.cpsa.ab.ca/PhysicianSearch/SearchResults.aspx?Specialty=Dermatology).

Finally, it has been noted within the medical community that an increasing number of people are seeking the advice of non-dermatologist physicians for their advanced or more complicated skin care needs. It is understandable and not surprising that patients see a general practitioner for common skin conditions given that the population has increased faster than our number of dermatologist has, the fact that most dermatologists are located in large urban centres, hours away from most smaller cities and towns, and that there are notoriously long wait times before a patient can get an appointment with a dermatologist. Importantly, this is not a problem in most cases, as most general practitioners are trained and are competent to be able to correctly diagnose and treat common skin conditions, at least initially.

Where the concerning trend lies, is that patient’s are continuing to see non-dermatologist physicians for more advanced skin conditions or for treatment of common skin conditions even after multiple previous treatment attempts have been unsuccessful without being referred to a dermatologist. An example would be a case of teenage acne that has been unsuccessfully treated for several years by a non-dermatologist physician, but which has persisted and now causes permanent scarring. A second example would be a young woman treated for several years for eczema on her face, when in fact, the correct diagnosis was skin cancer that now requires more advanced surgery to treat. It would be strongly recommended that these patients be referred to a dermatologist for assessment and treatment sooner.

Interestingly, in a growing number of medical specialties, among them dermatology, there appears to be increasing confusion within the public as to what constitutes a Medical or Surgical Specialist, and who determines who is a Specialist. The Royal College of Physicians and Surgeons of Canada (RCPSC) is the national organization responsible for determining the required education, training and examination of all medical and surgical specialists (including dermatology) in Canada. The Royal College itself has determined that there is a lack of awareness in the Canadian public as to what it means to be a medical or surgical specialist accredited by the Royal College. To this end, the Royal College has recently launched a nationwide media campaign hoping to educate Canadians on this important subject: what does it mean to be an accredited specialist with the Royal College, and how this accreditation ultimately translates to a higher level of quality of care for the patient in terms of the required education, skills, expertise and commitment to advanced learning of their specialist.

You can read more about this information campaign on the Royal College microsite. Simply copy the following web address and paste it into your browser’s search bar. https://fellowshipmatters.royalcollege.ca/fellowshipmatters/en/index.html

If diagnosing and treating skin-related symptoms, diseases and concerns sounds like it should be, in my opinion, the principle responsibility of trained and licensed dermatologists, i.e. those who have studied, trained, been examined and been accredited by the Royal College as specialists in the field of dermatology, then you are absolutely correct. A patient who would like to see a professional regarding anything but the most straightforward, common issues related to their skin’s health should request to see a Royal College accredited Dermatologist. The Canadian dermatology community is anxious to communicate that seeing non-dermatologist physicians who propose to be a “skin specialist”, let alone seeking the advice of non-physicians who claim to be any degree of a “skin specialist,” can lead to serious consequences to a patients health including incorrect diagnoses, inappropriate treatment choices, and treatment failure leading to unnecessary progression of disease, and complications like permanent scarring and even death in the case of a missed skin cancer, or other life threatening skin condition.

Those of us who live in Canmore, an area that has had limited local access to dermatology in the past and, in particular, advanced skin-related diagnoses and treatments, may feel like we’re exempt from this word of caution. But, as Canmore resident and Royal College accredited Dermatologist Dr. Paul Lubitz mentions, Canmore residents are not immune to such misrepresentation and would benefit from requesting to see a Canadian accredited dermatologist (FRCPC after their name) for their skin care needs.

“It really is critical,” Dr. Lubitz comments. “Just because a person, professional or not, labels themselves as a “skin specialist” does not mean that they have the necessary training and knowledge to diagnose and treat skin conditions appropriately. Since I began work in Canmore four years ago, I’ve seen increasing instances of patients that have been incorrectly or unsuccessfully treated by quasi skin specialists, often with significant medical, psychological and financial costs to the patient. That’s an alarming trend that needs to stop.”

Dr. Lubitz himself is taking an active approach to combating these trends. Seeing the lack of advanced skin diagnosis and treatment options in the Bow Valley area, Dr. Lubitz opened a general medical and surgical dermatology clinic operating out of the Canmore General Hospital in late 2010. To complement these general dermatology services, Dr. Lubitz will be opening his own private clinic called Art of SKIN Dermatology, Laser and Cosmetic Surgery in downtown Canmore in late July 2014. Art of SKIN Dermatology, Laser and Cosmetic Surgery will offer a broad range of advanced skin diagnostic and treatment options, including comprehensive medical, surgical, laser and cosmetic treatment options and will function in addition to his Bow Valley Dermatology Clinic at the Canmore General Hospital.

“I’m truly very excited about the opening of Art of SKIN Dermatology, Laser and Cosmetic Surgery,” Dr. Lubitz adds. “It will bring advanced skin care treatments to the Canmore area, and perhaps most importantly, this clinic will do its part in mitigating the trend of residents seeing non-dermatologists and even non-physicians for issues related to their skin’s health. That’s very important.”

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