Adding 'Gen Z' to the Differential Diagnosis

Adding 'Gen Z' to the Differential Diagnosis

Glen Ellyn's Andrew Tran, a DCMS student member at Tulane, and his younger sister, Kaitlyn Tran, share thoughts on generational difference in this Member Pulse. All views are those of the authors.


ANDREW: I was looking at an odd rash – or something that looked like a rash – during a virtual conference. The speaker displayed a peculiar, rhomboid plaque with central pallor and surrounding erythema. Even more unusual, this diamond-shaped lesion repeated down the forearm. I was stumped; I had no clue what caused the strange plaque.

Eventually the presenter revealed that the rash or lesion was due to applying salt and ice to the forearm. I'll be honest, that was definitely not on my differential. I even Googled "diamond rash on forearm" and pictures of psoriasis and allergic reactions popped up – not salt and ice. 

Interestingly, when I showed my sister the image she immediately diagnosed it as the "Salt and Ice Challenge" from TikTok. My sister is in high school and has had no medical training. But she does have expertise as a Gen-Zer – the generation of Americans similar to Millennials, like me, but according to the Pew Research Center, also the most educated, technologically savvy, and ethnically diverse generation yet. This combination of traits adds to and challenges our collective conversation and identity and in some cases like mine, offers valuable knowledge for our profession. 

Although unexpected, my sister now joins the group of professors, colleagues, and patients that have offered their unique experiences to help shape my education. Given my learning experience, I encourage others to welcome our younger peers to the table and listen to what they have to say. 

KAITLYN: Born as the first digital natives, Gen Zers take full advantage of it in becoming modern-day innovators, educators, and reformers. The internet and social media support our worldwide connection and collaboration with others. Gen Zers exhibit great courage to go beyond the norms established by previous generations. 

Gen Zers make great experimenters, testing one trend after another – each one leaving a unique impact. However, a downside to some influential trends is the hidden underlying danger behind them. Is this risky? What are the consequences? Those concerns are seldom raised and tend to go unnoticed by Gen Z. 

Unintended consequences occur from time to time, but one positive takeaway could be a potential lesson to be learned and taught to others. To my surprise, I found myself having to explain the popular “Salt and Ice Challenge” to my clueless older brother – a Millennial.

Gen Z is the future. Curious, we strive to be educated and continue to investigate answers to the unknown. I hope the trends we explore or the new measures we create can ultimately help make the world a better place. 

COVID-19 Vaccine Distribution Webinar

December 16, DCMS hosted a webinar on COVID-19 vaccine distribution featuring Rashmi Chugh, MD, MPH, Medical Director of the DuPage County Health Department. This will be the first of many webinars for the next few months. Click here for the slides to the webinar. Click here for a recording to the webinar.

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/health/skin-diseases-black-

hispanic.html

[2]Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Social Science & Medicine. 2018;202:38-42