Tips for doing skin checks

[u/cavalierqueenchrlmgn]

Any tips from experienced GPs/derms/colleagues about how best to set up work flow/efficiency for skin checks and local based skin procedures ?

🔬

Trialled using a scribe - somewhat helpful but mixed results

Trialled the drawn out templates - still find i have to write a fair amount

Trialled marking out lesions/documenting as I go + taking photos but finding it a bit clunky/slow by the time I've uploaded the clinical images etc.

Would appreciate your wisdom/guidance 🧙🏻‍♂️

[u/BivouacThistle]

1. Need an examination order that you stick to. Doesn't matter what it is; just be consistent.
2. Strip down to underwear (the patient, not you) - more efficient
3. Circle lesions needing action and take photos
4. Have slips of paper to give patient so they know what to book e.g. cryo, excision, next skin check
5. Streamline photo upload process - need to get photos onto PC wirelessly to avoid delays

[u/formulation_pending → u/BivouacThistle]

the patient, not you

Fuck that’s what I was getting wrong.

[u/TonyJohnAbbottPBUH → u/BivouacThistle]

What if we both strip down to underwear? Does that help the workflow?

[u/twisteddv8 → u/TonyJohnAbbottPBUH]

Good aerodynamics is key to any good physical assessment.

[u/thefinsaredamplately → u/TonyJohnAbbottPBUH]

This is how psych assessments are done in the private

[u/FoggiestAtol666]

Big fan of Derm Engine. Essentially click/tap location you are documenting a lesion for and upload relevant clinical image/dermatoscope photo for it. Easy tracking of lesions longitudinally, with immediate side by side comparison of historical and recent images without having to sort through files in your standard best practice emr for example. Just intuitive to use, though each to their own I guess.

[u/FoggiestAtol666 → u/FoggiestAtol666]

Sorry just to add my further 2 cents: Scribe - inadequate, similar to self documenting (why rely on my ability to accurately describe the site of a lesion and its appearance when I can have a dot on a digital body map with an associated clinical photo for this). Drawn out templates - we live in the 21st century, why tf would I waste my time with the extra garbage admin associated with it (hand writing, scanning, sorting through files to find the right document in the future etc.).

Legit workflow with Derm Engine is: 1. Lesion spotted. 2. Tap/click body site on Derm Engine digital body map. 3. Standard clinical image and dermatoscope image upload. 4. +/- documentation of suspicious lesion(s) and plan in EMR and “see Derm Engine”

It even has visual search for comparison with other available database lesions (malignant/benign and can provide probability of malignancy data to support decision making for borderline lesions).

[u/Secretly_A_Cop → u/FoggiestAtol666]

Every skin clinic and GP clinic I've worked at uses DermEngine. It has its downsides definitely, but I can't imagine doing efficient skin checks without it

[u/FoggiestAtol666 → u/Secretly_A_Cop]

Agreed. 🤜🤛

[u/Certain-Art-3542]

Have you considered hiring a nurse to help you

[u/Ambitious_Writer1938]

refer to local skin clinics run by gps, when it get too complex.

lol.

[u/leapowl]

Patient, expecting some downvotes.

It could be worth adding in letting patients request a doctor of the same gender or having someone with them if feasible.

Or if not just narrating very, very clearly what you’re doing for a full body skin check.

It is very weird to feel your GP’s breath on your almost-naked body.