Welcome Back: Medical students open free clinic to treat skin disorders

Joel Wolf, a Pitt medical student who co-founded a free dermatology clinic last October, said the model for his free clinic works because diagnosing skin conditions usually doesn’t require expensive equipment.

“The whole point of dermatology is that you diagnose with your eyes,” Wolf said.

Wolf, a third-year medical student, and Tory Steen, another student at Pitt’s School of Medicine, developed and established the Student Dermatology for the Underserved, a free dermatology clinic that runs at the Squirrel Hill Health Center every six to eight weeks, usually on Tuesday evenings. The clinic sees between 10 and 20 patients at each session. 

Although doctors oversee the clinic, it’s entirely student-run, which offers an opportunity for medical students to fulfill their community service requirement and also gain a deeper understanding of dermatology. Depending on the schedules of those involved, a session will see about two to four overseeing doctors, two to three residents and two to six students. 

Students study dermatology for about a week in an online class at the School of Medicine, Steen said. “It’s not covered in-depth much at all, which is fine because only one person in a class out of 150 is going to go into dermatology,” Steen said.

According to Wolf, the free dermatology clinic is fairly low-maintenance because of the relatively low cost of diagnostic equipment.

Wolf came up with the idea of Student Dermatology for the Undeserved after shadowing ophthalmologists at the Birmingham Free Clinic in South Side. He saw that doctors, residents and students worked together to bring in eye equipment and complete eye exams and realized that the same could be done for dermatology.

Wolf took the idea to Steen. When they reached out to doctors at the School of Medicine’s dermatology department, they found a lot of support. Wolf realized that because biopsies and finding doctors to read slides would cost money, they would need financial backing. Pitt’s dermatology department partially funds the equipment.

After contacting the pathology department at Pitt, Wolf enlisted the voluntary services of Jonhan Ho, director of the Dermatopathology Unit and a professor in the departments of dermatology and pathology at Pitt. As a dermatopathologist, Ho analyzes biopsy results under a microscope and makes diagnoses based on his judgment. After he makes the diagnosis, the attending dermatologist decides the course of action. 

Though he does not work directly with the patients, Ho reads a lot of slides — about 10 from each clinic he works with — and makes a portion of diagnoses. 

“It’s getting used, so in that respect, I think it’s effective,” Ho said of the clinic Steen and Wolf created. 

 Steen said he and Wolf were very fortunate to have previous models for their clinic. There are many different student-run volunteer groups through the School of Medicine. She and Wolf modeled the dermatology clinic on the previously established Guerilla Eye Service, a free eye-care service also provided through SHHC.

Wolf and Steen brought together students, residents and attending physicians – attendings – and developed a plan. To put the clinic into action, the students needed a space, and Wolf found it after attending a lecture by Andrea Fox, chief medical officer at SHHC. Fox was interested in Wolf and Steen’s idea and helped them sort out insurance issues and start the clinic at SHHC.

In the 10 months that the clinic has operated, student volunteers have diagnosed lupus, small melanomas, benign skin cancers and other diseases. Patients come to the dermatology clinic after receiving recommendations from primary care doctors who work in general care at SHHC.

Wolf said the work he and the students do at the clinic is interesting because they often have to think of novel ways to treat patients. 

Although diagnoses are inexpensive, treating skin disorders does cost money. Because the patients are uninsured and the clinic has limited funds, doctors at the clinic don’t always have access to certain medications. According to Wolf, certain topical creams and steroids are readily available, but more specialized medicine is hard to come by.

“I had a patient with chronic urticarial,” Wolf said. “It’s an inflammatory disease, and there are certain drugs that are out there now that have just come out in the last couple years. They are very expensive, so we used a different regimen of over-the-counter allergy medications to deal with it.”

Wolf said that these more difficult processes give students a deeper awareness of alternative ways to treat patients.

“It’s a win-win for everybody,” Wolf said. “The students get hands-on experience, and the uninsured patients get specialized care.”