This past month I have been a visiting medical student in Dermatology at the University of Washington. Thanks to Dr. Jennifer Gardner and her dedication to One Health, I had the opportunity to observe in a practice setting that few medical students ever experience. I spent one day per week with Dr. David Duclos, a veterinary dermatologist with a well-established private practice and loyal patient panel.
In a serene office with window views of trees and birds on well-stocked feeders, Dr. Duclos sees cats and dogs with skin, fur, ear, nose, and nail complaints. Many of the most common conditions, such as allergies and atopic dermatitis, superficial infections, and autoimmune disease are nearly identical to those I’ve encountered and learned about in human dermatology.
We met a sweet, large, black mixed breed dog who could not stop itching. His paws and the skin on his belly were red and flaky, and the fur along his ventral side was sparse. The clients were worried about an infection that was not being treated. Dr. Duclos’s history focused not just on the dog’s symptoms, but also his environment. Where does he go outside? Does he sneeze more after you mow the lawn? Does anyone in the house smoke? His owners were distraught, but the patient fit the atopic dog profile exactly. I could easily recognize the similarities between this dog and the many children with atopic dermatitis I have seen at my home institution. Dr. Duclos’s questions about the dog’s environment underscored the importance of a One Health approach and knowledge of the local flora and fauna to identify the patient’s triggers for flares.
In addition to observing the canine and feline version of many dermatological diseases, I had the pleasure of meeting two 4th year veterinary students. Both were enormously helpful in teaching me throughout the day. In discussing patients with Dr. Duclos, we would invariably explore the similarities and differences in how one would approach this problem in a human versus animal. For example, in wound care many of the same products and approaches are used. Petroleum jelly and honey are favored; topical antibiotics, especially those with neomycin, are avoided because of the potential for sensitization – a risk in both human and animal patients. We frequently discussed antibiotic resistance and the utility of skin culture susceptibilities. Over lunch we had a fascinating talk on how animals, both legally and illegally imported, could bring diseases like leishmaniasis from other countries, which could impact both human and animal health. As the environment changes, the prevalence of diseases and vectors of transmission will be impossible to characterize without ongoing collaboration between environmentalists, veterinarians, and physicians.
I hope that this introduction to working with my veterinarian colleagues will be the beginning of a lifetime of collaboration. We are asking many of the same questions with the goal of finding solutions that will benefit our patients. Animals and humans evolved together in a shared environment. The institutional separation between MDs and VMDs does not reflect the reality of life on earth. I will continue to remind my physician colleagues of the parallel world of veterinary medicine and encourage collaborative intersection, for the good of all our patients.
By Hannah Singer,
M.D. Candidate, Class of 2018
Columbia University College of Physicians and Surgeons