MP-Andrew Tran
DCMS member Andrew Tran is a fourth year medical Student at Tulane University. A Glen Ellyn native, he received scholarship grants from our DuPage Medical Society Foundation each of the past four years, awarded in recognition of his outstanding academic abilities coupled with important service and leadership activities. He shares some of what's currently on his mind in this Member Pulse. All views are the author's.Skin of Color: A Missing Curriculum
In a recent clinical elective I came across a suspected case of cellulitis. The patient's presentation was textbook: skin warm and painful to the touch, evidence of swelling under the skin, slight fever. Missing, however, was one important clue: the red rash. I reviewed the literature and found dozens of photos showcasing the classic red rash on light-skinned individuals. But my patient had dark skin with a brown-black rash. Once certain, I now doubted my diagnosis.My predicament is not unique. In a recent New York Times article, "Dermatology Has a Problem With Skin Color," the author highlights this problem in medicine[1]. In medical school, we learn to recognize patterns and associations to diagnose patients. The many photos of cellulitis I've seen in my readings and lectures were all of light-skinned individuals. In contrast to examining X-rays, where interpretation relies on recognizing subtle changes between shades of black and white, analyzing a patient's skin encompasses a wider range of color variability and requires greater attention.
A study examining medical textbook images found that although racial distributions were close to that of the U.S. population, pictures of dark skin tone were under-represented[2]. Such limited exposure – as I experienced – can lead to pitfalls and treatment delays.
Throughout my training, I've heard variations of the phrase, "I don't see color" expressed with good intent. In some cases, however, this attitude isn't helpful and may be harmful.
Being "colorblind" is valid when looking at X-rays, but probably not the appropriate approach for diseases of the skin. With the help of VisualDx – an app that houses pictures of many skin diseases with a wider range of skin colors than the average textbook – I was able to confirm my patient's diagnosis and properly treat his cellulitis.
For me, the clinical pearl in this experience is the importance of learning what physical symptoms look like in patients of all colors. As Dr. Lester says in the article, "if you're only trained to look at something in one color, you won't recognize it in another color." Our efforts to be lifelong learners should not be limited to what we see in textbooks, but also include the perspectives of our patients.
References
[1]Rabin RC. Dermatology Has a Problem With Skin Color. The New York Times, The New
York Times, 30 Aug. 2020, www.nytimes.com/2020/08/30/
hispanic.html
[2]Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Social Science & Medicine. 2018;202:38-42