A Differentially Diagnosis By Alanna Douglas

Have you ever looked at a skin in consult and thought what the heck is that? Clients are coming into our treatment rooms with complex pigmentation, vascular conditions and seriously impaired barriers. So where do we start and how do we end up with a “diagnosis”.

Are you ready to open a can of worms? Here we go!

Let me breakdown the “diagnosis” although as skin obsessed, educated beings, we cannot officially “diagnose” a condition. We leave that part to Doctors and Dermatologists. Now here comes the tricky bit, we need to be able to differentially diagnose (that means be able to tell the difference between one condition and the other) to be able to create a treatment plan and select a homecare regimen. If we don’t do this, we are not doing our job, so no wonder why we are confused and baffled sometimes when it comes to selecting a treatment plan or recommending products. The pressure to get it right is huge!

So, when do we refer and when do we use our knowledge database? That is a loaded question and there are so many ways to tackle this, here is my guide. If its raised, a different colour, has an irregular border, is oozing a weird substance, has been there for more than a few weeks or just does not look right I always send for a second opinion and if necessary, clearance to treat. Even if you are 99% sure it always a good idea to just get it checked, especially if you are going to be using light-based treatments in the future. I also have a team of other allied health professionals that I have curated relationships with, and we work well together on a referral basis. It’s like sending your clients to your favourite gym or hairdresser, except they are Doctors, Dermatologists and Plastic Surgeons.

Along with working interprofessional with other allied health practitioners I find tools in the treatment room super helpful. The more pictures and different types of the one condition you can get your eyeballs on the better! I have so many laminated sheets with conditions and pathophysiology so that I can easily pull up a photo and confirm my thoughts. Further to this, having information available to clients on their condition is a super powerful tool. One of the conditions I get the most questions about is pigmentation. It can be so tricky to understand what you are looking at. It looks so different in every skin tone and can be super stubborn to treat. If you’re reading this thinking this is me, don’t stress I have something for you! You need my guide to the most uncommon pigmented skin conditions and I have this sitting on my website free for you!

Now I want to just touch on (as briefly as I can this might be long) the working with other allied health professionals. Don’t get me wrong I love the team I work with now although finding them was hard and most days felt utterly gutting. I have had my fair share of clients come in saying that they had been diagnosed with dermatitis when they in fact had eczema. Further to that I have also written referrals for further investigation to have my client arrive back in my treatment room with none other than our favourite cream ever cortisone! Followed closely by another crowd favourite retrieve! Now this is where we must put our thinking caps on and be very real and honest with our communication. It is our job to enable our clients to make an educated decision, all we can do is provide them with the information. If they decide not to agree that’s totally ok! You will find they will swing back into your books within the next 6 months when the quick fix has stopped working.

Before we go ahead and label the medical profession as the problem let’s take a minute to understand their world. We can’t really fault the Doctor or Dermatologist if they get the diagnosis wrong or prescribe a quick fix. We are trained so completely different, and we have different levels of liability. A registered medical practitioner can only prescribe evidence-based care, which means essential fatty acids aren’t going to be on the menu. They also have patients arriving in their offices wanting solutions yesterday and there is a huge amount of pressure to give a prescription. Not to mention they are given 15minutes with a patient (this needs to change but that’s for another day another article). Now these magic pills and creams just mask the problem, and this is where we step in.

As clinicians we can work wholistically with our clients, spend time getting to know them, really understand exactly what’s happening and why their skin is showing signs of their declining health. We don’t have the power to prescribe medications, but we have things much more powerful than medication that create lifelong change! This is a skill that is rare, and our profession is teaming with magical clinicians who can wave their wand over a client and deliver them amazing outcomes and life changing results! Would I like us to have more ability to work with our clients without the need of another medical professional? Absolutely! Is it happening anytime soon? It’s not looking good. I’m going to leave you with a thought, what if we took the burden off doctors and were able to fully manage a client’s skin health? What if there was a way to recognise our higher education as clinicians, they already exist, and they are called Dermal Clinicians!

Alanna Douglas

www.skinfreakacademy.com.au

hello@skinfreakacademy.com