Physician at Work: A dermatologist uses her eyes to spot disease
For Jean Bolognia, MD, her interest in colors and shapes—which can prove useful in a specialty that relies on visual acuity—was what led her to specialize in dermatology. While she was a medical student on her dermatology rotation, she diagnosed a rare disease in a patient at grand rounds based on a picture she had seen in Skin Signs of Systemic Disease, by Irwin Braverman, MD, professor of dermatology. Based on a number of visual recognition experiences and after a stint in internal medicine, she realized that she wanted to practice dermatology.
Dermatology remains one of the specialties in which diagnoses are often made without ordering blood tests or radiographic studies, as they are based instead on what the physician sees and feels, plus histologic examination of selected lesions. Having top-notch dermatopathologists as colleagues is crucial to the care of the patient, Bolognia says.
Many of her patients have numerous—perhaps even hundreds—of melanocytic nevi (moles) and may have had multiple primary cutaneous melanomas and/or a family history of melanoma. Bolognia collaborates with other dermatologists, often alternating visits for at-risk patients who live a fair distance from New Haven. “Having two sets of eyes can actually aid in a patient’s care,” she said.
Bolognia uses a dermatoscope, a magnifying glass with polarized light, to examine lesions with such atypical features as irregularities in outline or color. She does a biopsy on the most worrisome lesions and refers patients who need surgical excisions to another dermatologist, dermatologic surgeon, or plastic surgeon, although the patients continue to have total body skin examinations for the rest of their lives. She gets to know entire families, since she tends to see the children and other relatives of her melanoma patients.
Over the years, Bolognia has noticed that the cutaneous melanomas she and her colleagues biopsy and diagnose have become thinner—the depth of invasion is often less than a millimeter and the prognosis is better. However, the job of the dermatologist has become more difficult because thin melanomas can be more subtle in their clinical appearance.
Originally published in the October 2009 issue of Yale Practice.
Click here for Dr. Bolognia's YMG physician profile.
Name: Jean Bolognia, MD
Title: Professor of dermatology
Area of expertise: Pigmented lesions
Place of birth: Hammond, Ind.
Age: 54
College: Douglass College
Med School: Yale School of Medicine
Training: Internal medicine, dermatology, and dermatology research, all at Yale-New Haven Hospital
Family: Husband Dennis Cooper, MD, who is also a faculty member
What is most challenging to you in academic medicine? The need for an infrastructure that can perform complex tasks and that has both problem-identifying
and problem-solving abilities.
What is most rewarding? Establishing the diagnosis in difficult-to-diagnose patients, taking care of patients who need a tertiary level of medical care, the opportunity to observe the entire spectrum of a particular disorder and then synthesize the information
for others, and the easy access to experts in
a wide range of specialties.
What do you like most about your practice? Besides those patients who bring a smile to my face, I am lucky to have worked with Sandy Somma, RN, for almost 20 years, medical assistant Lisa Lee for nearly 10 years, and practice manager Karen Piscitelli for over a decade. Having people at our front desk who are responsive to my needs and the needs of my patients is icing on the cake.
Personal interests or pastimes: I enjoy traveling and watching football. I am also interested in the wins and losses of the Chicago Cubs, both during the regular season and spring training.
Last book read: Scarpetta, by Patricia Cornwell
What would you do to improve our clinical environment if you had a magic wand? Not limit RVUs to just physicians; have a designated point-person
for every clinical department who assists in intragroup referrals and is listed as such in the YMG physician directory; a physician-specific IT team that is well versed in PDA-computer interactions; an integrated EMR with efficient transfer of information between the hospital and university; and lastly for my husband, a better server for the computer system so when he puts in orders, he doesn’t have to wait 10 minutes for the drug entry screen to appear.
