Forbes India 15th Anniversary Special

Transformation of the Steroid Cream Doctor

Dr. Rajan TD, MD, DVD, DNB, PGDMLS, Dermatologist and Venereologist, Teacher, Writer, Motivator and Dermatologist, Doctors Centre, Mumbai

Published: Oct 25, 2021 04:03:00 PM IST
Updated: Oct 25, 2021 04:10:49 PM IST

Transformation of the Steroid Cream Doctor

The dermatologist of today can boast of having a prominent place among doctors with his specialty being sought after by aspiring medicos. These days, with every Tom, Dick and Mary wanting to look like a hero/heroine irrespective of age, for the student who manages to get the coveted dermatology seat, life looks very promising. Private medical colleges in most countries demand a King's ransom to procure a postgraduate seat in the subject which comes very close to branches like radiology and cardiology.

Things were much different when most people of our as well as the older generation entered the field of dermatology. About three decades ago, the day one of our MBBS colleagues announced at home that he has opted for this branch for his post graduation, his father shouted, “My God, did you not get admission in any good branch?” Another parent remarked, “How will you give a good life to your family?” They were unwilling to accept our response that the speciality catered to the care and treatment of the largest organ in the whole body – almost double the weight of the brain or the liver!

Although it sounded very demeaning to speak about a speciality of medicine in such derogatory terms, the sad reality was that our speciality was considered a “left-over branch.” It was meant for the dull and idle.

It was a department that had no “cures!” Physicians cure typhoid, malaria, TB. Surgeons cure appendicitis, IHD. Orthopedic surgeons restore fractured limbs. Obst-Gynaecologists deliver babies.  Ophthalmologists restore sight in cataract. Pathologists and radiologists do tests and deliver reports to help “real” doctors! What do dermatologists do? Eczema, lichen planus, psoriasis, alopecia, ……… name it and we don't have a cure!

Yet they were not idle, they certainly captured the moment with a quick clinical photograph!

'1-1-1 Doctor'

As we got into our Resident Medical Officer 'house posts' (now called junior residency) we began to get labeled with various nicknames. They went on and on with their snide remarks about how skin patients who never get well and never die! Others asked, “Aren't you the Betnovate doctor?” obviously implying that we only peddle steroids to our patients.

The most irritating one was the story of how one GP father-in-law gave his dermatologist son-in-law a patient of Psoriasis – as dowry!

Colleagues poked fun at the Dermat Resident Doctor saying we were 1-1-1 doctors. “Why?” I wondered. Only after persistent prodding did someone care to explain: Referring to one of our senior professor who barely moved from his seat during the entire three-hour OPD, he elaborated: “You all use just one neck muscle to work (sternocleidomastoid), one equipment to make a diagnosis (magnifying hand lens) and prescribe just one drug (Betnovate). One-one-one!!!

Tough beginning

Most privately practising dermatologists began their practice after buying one hand lens, molluscum curette and an electrocautery machine. Not a soul would trickle into his clinic in the early days, since the GP himself could prescribe the ubiquitous steroid cream! The only people who actually visited the dermatologist were the relatives of GPs who got free consultation and the occasional patient of chronic eczema or the leprosy patient whom nobody wanted to treat.

Male dermatologists would get the occasional patient of Gonorrhea, Herpes or Chancroid. Female dermatologists would get patients with acne and pruritus vulvae.

Those days, patients of hairfall and pigmentation would prefer to ignore their condition. Urticaria patients were content with Avil, even though though it put them to sleep during work! Just as the dermatologist became senior and a sizeable number of patients started visiting him, technology underwent a transformation.

Lens to lasers

The era of the late 1990s brought in Chemical peels, Radiofrequency machines, Lasers etc. Gradually, there were lecture demonstrations on anti-ageing therapies, PRP, thread-lifts and Botox injections. The specialty which was treating incurable skin disorders shifted to making people look young and beautiful. 'So what if the itch in the groin doesn't go away, I-can-make-you-pretty-young' seemed to be the mantra of the new generation dermatologist alias cosmetologist.

The electrocautery machine disappeared and it was replaced by radiofrequency devices and high-tech lasers. Dermatology clinics were no longer tiny 8'x 8' consulting rooms but evolved into a multi-cabin cosmetic centre which hired a plastic surgeon and female assistants to service his patients.

Big bucks

The young dermatologist began his practice with a flourish and rising confidence. The seniors who by now had busy practice had to catch up with the modern technology. The skeptical ones who dismissed cosmetic practice as a passing fancy were now afraid of being left behind.

At the same time the youngster who forgot all about skin diseases and failed to consolidate basic dermatology practice and plunged headlong into cosmetic practice, faced the risk of not being able to satisfy patients with 'imaginary' scars and marks.

The consultation fees of Rs. 100 - 200/- (equivalent to US$ 5 – 10/-, three decades ago) shot up 10 to 20 times with the use of newer technologies. The modern-day Derma Cosmetologist laughed all the way to the bank even and also slept well, even as the physician, gynecologist, surgeon and the cardiologist struggled with their life-threatening cases all round-the-clock.

Dermatologists branched into the field of skin surgery, hair transplantation and made inroads into their related specialties of general surgery and Plastic surgery.

33% greater area!

Thirty years ago, most men and women wore clothes that only exposed less than 27% of their body surface, at least in the conservative Indian subcontinent. So a black mark on their shoulder or upper back would go unnoticed – and hence untreated. Also minor variations in pigment in the axilla or knees were not visible to others except in the swimming pool.

Now, with men wearing sleeveless T-shirts and shorts and women wearing spaghetti straps, minis and much less, as much as 60% of the surface could lie exposed. So stretch marks on the thighs and a mole above the breasts look ugly when they peep out! That provides a whopping 33% extra body surface for the dermatologist/cosmetologist to treat! Isn't that like a 33% increase in patient load for the modern dermatologist?

The once disapproved speciality had finally come under the spotlight! As someone aptly put it, “Their itch couldn't make us rich but the shine on patient's faces did!”

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