'Skin clinic' gives non-specialists valuable experience

Pam Adams

Elaine Tieber and the doctor joke back and forth as he examines the small brown spots on her back. The doctor, Thomas Goleman, brims with a folksy, Southern manner, and Tieber has a sense of humor to match.

She's had two cancerous lesions removed in the past by other doctors. When her husband noticed one of the spots on her back had changed color, she called Methodist Family Medical Center, where she's a regular patient.

"I thought they were going to send me to a dermatologist," she says. "But they said, 'Oh, you can just come to the skin clinic.'"

Two weeks later, here she is, on a Wednesday morning, back where she started, at Methodist's family clinic, a stone's throw from the University of Illinois College of Medicine. This time, however, her regular clinic is a special clinic, and her regular family doctor is performing a quasi-special function.

They banter as Goleman essentially kills spots of skin off her back. He dips a cotton swab into a styrofoam cup of liquid nitrogen and gently dabs it on each spot. At a temperature of minus 500 degrees Fahrenheit, liquid nitrogen freezes anything it touches so quickly that it would destroy the plumbing if doctors poured it down the drain.

Instead, Dr. Jennifer Stevens, who is observing Goleman, pours the leftover liquid on the floor. It evaporates in a puff of smoke.

Though Tieber came in because of one spot, Goleman says he figured he'd remove the others.

"No, he just wanted to practice," Tieber jokes.

Actually, Methodist Family Medical Center's "skin clinic" is just that, a place for doctors to practice.

Skin deep

Little-known and informally titled, the "skin clinic," or "derm clinic," is part clinic for patients with skin problems or disorders, part teaching lab for doctors in the College of Medicine's family residency program, which Methodist sponsors.

Goleman, director of the family residency program at the College of Medicine, makes it a point to let patients know he's a family practice doctor, not a dermatologist. As a professor who teaches family medicine, he teaches while he works.

He and Dr. Jared Rogers started the derm clinic about three years ago because they saw an opportunity to meet several needs.

Between 60 and 70 percent of the clinic's patients are on Medicaid or Medicare, Goleman explains. "A lot of our patients had difficulty getting in to see a dermatologist. It was expensive, and if they didn't have regular insurance, there was a long wait for an appointment."

After 30 years in family practice, Goleman also knew family practice doctors see a lot of "run-of-the-mill" skin problems - rashes, acne and non-cancerous lumps and bumps.

"Family docs do a lot of dermatology," he says. "They need to be knowledgeable about what they're seeing and how to treat it."

Before he and Rogers started the "derm clinic," family practice residents would spend time with local specialists to get dermatological experience.

"They got the volume, but they didn't get to do anything with their hands," Goleman says. "Plus, these guys in private practice are very, very busy. They didn't have time to talk about what they were doing."

A 'win-win-win situation'

As word about the skin clinic has spread, it's expanded from one half-day a week to four half-days a week. Its caseload has grown to include the clinic's regular patients, Methodist employees and a few insurers who have had difficulty enlisting a dermatologist in their health care plan.

Goleman sees the derm clinic as one of those "odd win-win-win situations."

"At first, we thought we'd offend dermatologists, but if anything, they've appreciated us."

Underserved patients get better access to specialized and nearly specialized medical care, and patients with regular insurance get the care at cheaper costs. Family practice residents get more hands-on training. And, when the skin clinic refers patients to a specialist (usually a dermatologist or plastic surgeon), the specialist already knows it's probably something more serious than what a family doctor can handle.

Goleman estimates they refer about 20 percent of their cases to a specialist. Tieber's spots were benign. Had they been more serious, she would have been referred to a specialist.

As he swabs her last spot, he assures her she shouldn't experience any bleeding or other complications.

"And don't forget to tell your husband these other spots will get darker, too," he says.

For her part, Tieber says the freezing swabs didn't hurt.

"I've stuck myself worse with pins and needles."

Pam Adams can be reached at 686-3245 or