Clipping Board » Medical Harm ─ Unnecessary or inappropriate medical procedures can also cause harm.
Author: Huang Huiru / Common Health Magazine 2015-12-31
I used to be the head of the dermatology department at a major hospital. What I could do, other doctors could do too, and what other doctors could do, I could do as well. Later, I opened my own practice, and business was good. In the first year that laser skin resurfacing was introduced in Taiwan, I performed 5,000 to 7,000 procedures. The occupational shoulder injury I sustained from that time still hasn’t healed to this day.
By the time I reached 10,000 procedures, I encountered something strange. This patient came in and only mentioned that she had experienced skin hyperpigmentation after undergoing fractional laser treatment with another doctor. After I treated her three or four times, her condition improved, but then the hyperpigmentation returned. I treated her again, and it improved once more. This cycle repeated several times, and I felt something was off—it shouldn’t be happening, it was very odd.
In the past, even if a patient’s skin darkened after laser treatment, it wouldn’t get worse. But with this patient, within seven days after treatment, her skin would immediately darken again, even worse than before.
If the skin darkened after a month, it could be considered post-inflammatory hyperpigmentation. But seven days? Melanin couldn’t rise that quickly. I also tried glycolic acid and salicylic acid treatments, and her skin improved by 90%. However, as soon as she stopped using salicylic acid, the hyperpigmentation would return immediately.
I consulted every skincare and cosmetic company I could think of, but no one had a solution. Later, I found out she had undergone treatment at another dermatology clinic 14 months prior and had been dealing with hyperpigmentation for 14 months. Adding the three months I treated her, it still couldn’t be resolved. I gave up.
I had to revisit the medical theory and realized that skin can be categorized into healthy skin and diseased skin. Dark spots are the result of inflammation—no inflammation, no spots. People with spots may either be post-inflammatory or currently inflamed. For post-inflammatory cases, laser treatment can correct the issue, but for those currently inflamed, laser treatment will worsen the condition. Damaged skin needs rest, not laser procedures.
A question that remained unanswered for a long time
In fact, ever since I started learning about lasers 10 years ago, a question lingered in my mind.
In medicine, young doctors usually learn from senior doctors or experienced professors. But why is it that with lasers, it’s the manufacturers who teach doctors? A junior colleague once asked me in confusion: while she was learning laser treatment, halfway through, a sales rep from the equipment company said, “Doctor, step aside, let me do it—I’m better at this than you.” She asked me, “Isn’t it legally required that only doctors can perform laser treatments?”
Because medicine is full of unknowns, doctors are trained in physiology and pathology. When something unexpected happens, doctors know to be alert, avoid known risks, and manage unknown ones. Equipment manufacturers can teach you what settings to use for different skin types, but if skin problems arise, they can’t guide you.
Later, I went to Singapore to learn from an experienced doctor. I asked him what parameters to use for melasma. He replied, “We are doctors. Doctors deal with patients’ physiological responses, not parameters.” Every clinical decision should be based on physiology, anatomy, and biochemistry. And if new discoveries emerge 10 years later, you can update your approach accordingly.
The patient I encountered was an example of this—the wrong patient receiving the right dosage. Even though the dosage was correct, it was used on the wrong patient. Too often, when something goes wrong, doctors blame the patient’s “special constitution” or skin type. That’s not right. Doctors are the ones who should assess skin conditions—how can they shift the blame to the patient?
Most patients who visit aesthetic clinics already have skin issues. Based on my experience, 60% have sensitive skin. So afterward, I became cautious about taking on patients and focused only on skin repair. Business started to decline.
The current state of medical aesthetics is like this because doctors have failed to demonstrate their value. When the medical field ventured into aesthetic medicine, it forgot to bring medicine along. Every group has its good and bad members. I believe most aesthetic doctors are simply ignorant, not malicious—because I used to operate the same way. But once I saw the harm done to patients firsthand, I stopped.Source: http://www. cw. com. tw/ article/ article. action? id=5073476
Confessions of A Dermatologist: I No Longer Want to Harm My Patients
I used to be the head of the dermatology department at a major hospital. What I could do, other doctors could do too, and what other doctors could do, I could do as well. Later, I opened my own practice, and business was good. In the first year that laser skin resurfacing was introduced in Taiwan, I performed 5,000 to 7,000 procedures. The occupational shoulder injury I sustained from that time still hasn’t healed to this day.
By the time I reached 10,000 procedures, I encountered something strange. This patient came in and only mentioned that she had experienced skin hyperpigmentation after undergoing fractional laser treatment with another doctor. After I treated her three or four times, her condition improved, but then the hyperpigmentation returned. I treated her again, and it improved once more. This cycle repeated several times, and I felt something was off—it shouldn’t be happening, it was very odd.
In the past, even if a patient’s skin darkened after laser treatment, it wouldn’t get worse. But with this patient, within seven days after treatment, her skin would immediately darken again, even worse than before.
If the skin darkened after a month, it could be considered post-inflammatory hyperpigmentation. But seven days? Melanin couldn’t rise that quickly. I also tried glycolic acid and salicylic acid treatments, and her skin improved by 90%. However, as soon as she stopped using salicylic acid, the hyperpigmentation would return immediately.
I consulted every skincare and cosmetic company I could think of, but no one had a solution. Later, I found out she had undergone treatment at another dermatology clinic 14 months prior and had been dealing with hyperpigmentation for 14 months. Adding the three months I treated her, it still couldn’t be resolved. I gave up.
I had to revisit the medical theory and realized that skin can be categorized into healthy skin and diseased skin. Dark spots are the result of inflammation—no inflammation, no spots. People with spots may either be post-inflammatory or currently inflamed. For post-inflammatory cases, laser treatment can correct the issue, but for those currently inflamed, laser treatment will worsen the condition. Damaged skin needs rest, not laser procedures.
A question that remained unanswered for a long time
In fact, ever since I started learning about lasers 10 years ago, a question lingered in my mind.
In medicine, young doctors usually learn from senior doctors or experienced professors. But why is it that with lasers, it’s the manufacturers who teach doctors? A junior colleague once asked me in confusion: while she was learning laser treatment, halfway through, a sales rep from the equipment company said, “Doctor, step aside, let me do it—I’m better at this than you.” She asked me, “Isn’t it legally required that only doctors can perform laser treatments?”
Because medicine is full of unknowns, doctors are trained in physiology and pathology. When something unexpected happens, doctors know to be alert, avoid known risks, and manage unknown ones. Equipment manufacturers can teach you what settings to use for different skin types, but if skin problems arise, they can’t guide you.
Later, I went to Singapore to learn from an experienced doctor. I asked him what parameters to use for melasma. He replied, “We are doctors. Doctors deal with patients’ physiological responses, not parameters.” Every clinical decision should be based on physiology, anatomy, and biochemistry. And if new discoveries emerge 10 years later, you can update your approach accordingly.
The patient I encountered was an example of this—the wrong patient receiving the right dosage. Even though the dosage was correct, it was used on the wrong patient. Too often, when something goes wrong, doctors blame the patient’s “special constitution” or skin type. That’s not right. Doctors are the ones who should assess skin conditions—how can they shift the blame to the patient?
Most patients who visit aesthetic clinics already have skin issues. Based on my experience, 60% have sensitive skin. So afterward, I became cautious about taking on patients and focused only on skin repair. Business started to decline.
The current state of medical aesthetics is like this because doctors have failed to demonstrate their value. When the medical field ventured into aesthetic medicine, it forgot to bring medicine along. Every group has its good and bad members. I believe most aesthetic doctors are simply ignorant, not malicious—because I used to operate the same way. But once I saw the harm done to patients firsthand, I stopped.Source: http://www. cw. com. tw/ article/ article. action? id=5073476