Sunday, 15 May 2016

Dermatology, aesthetic medicine and the private sector



"I do not like the cosmeticisation of dermatology - not what I did medicine to do," said Rona MacKie FRCP, in 2006 when asked about the dangers to the field of dermatology. In the following year, David Eedy FRCP wondered how the future generations would judge dermatologists’ preoccupation with the siren voices of cosmetic surgery. He added that dermatologists who heed the Delphic injunction to “know thyself” would be venerated.  He also added that dermatologists seriously run the risk of diluting their influence in medicine in general if they continue to follow the cosmetic route, which many other physicians quite rightly perceive is for financial gain rather than for the reasons why we all entered medicine in the first place. He believes that by not taking our careers in medicine seriously enough we will feel short-changed in the long term and less satisfied with the potential fullness of a career in dermatology.

The British National Health Service (NHS), the top model of a nationalised health system in the world, has recently been suffering a lot because higher costs have to be covered and now the private sector is apparently essential to maintain the NHS. It helps with the workload, brings new skills, and contributes to competition.  However, dermatology is a prime example of how government meddling is decimating the NHS through privatisation. Dermatology has been seen as an easy service for hard-pressed commissioners to shift ‘into the community’ with private providers, due to the widely held but mistaken view that skin diseases are minor ailments and can be easily identified and treated locally, reducing the burden on hospitals. The drive to shift treatment into the community leads to decommissioning of dermatology hospital services. There have been cases of private providers tendering for dermatology services without even having dermatologists or other appropriately trained staff in post!

In 2014, I referred to the risk Eedy referred to if the cosmetic route is being followed and I added that it certainly has taken place in many parts worldwide.


Few years ago, the British College of Aesthetic Medicine was established by general practitioners. Together with the British Association of Dermatologists, the British Association of Plastic Reconstructive and Aesthetic Surgeons, the British Association of Aesthetic Plastic Surgeons , and the British Association of Cosmetic Nurses, the newly established College will work to protect patients undergoing cosmetic interventions by improving and enforcing clinical standards and training, and by maintaining a register of practitioners. Whether the establishment of an independent Aesthetic Medicine College will stop dilution of dermatology influence in medicine or not remains to be seen.

This page was last updated in May 2016

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Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Ackerman's Resolving Quandaries in Dermatology, Pathology and Dermatopathology
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology