The Pro

Why this doc hates it when patients doc-hop

Dr Liew Hui Min says there is no "one-size-fits-all" solution in dermatology. She tailors an individualised treatment regime for each patient.
Dr Liew Hui Min says there is no "one-size-fits-all" solution in dermatology. She tailors an individualised treatment regime for each patient.ST PHOTO: KELVIN CHNG

Q I have a strong interest in dermatology because...

A I like to uncover the pathology of patients' skin conditions, as this helps guide us in our diagnosis and allows us to recommend the best treatment for the patient.

Q If I were to give an analogy for what I do, I'd be a...

A Counsellor, because I am there for my patients and their families when they are going through tough times. Severe skin conditions can impact their quality of life significantly.

I will work with them to tailor an individualised treatment regime. No one size fits all.

Q I come across all types of cases from...

A Those that affect the hair and body to the nails. My subspecialty interest training in paediatric dermatology and genital dermatology have put me in a comfortable position in managing simple to complex cases in these areas.

  • BioBox


    AGE: 40

    OCCUPATION: Specialist in dermatology and consultant, Raffles Skin & Aesthetics

    She completed her dermatology training at King's College Hospital in London and qualified as a dermatologist in 2012 in the UK.

    "My work experience in the United Kingdom brought me to some of the largest cities with both Asian and European communities, for example, London, Leicester and Glasgow, where I had the opportunity to examine and manage complex medical conditions," she said.

    Upon returning to Singapore in 2014, she served as a consultant in KK Women's and Children's Hospital (KKH). She is currently a visiting consultant there. Besides general adult dermatology, Dr Liew has special interests in paediatric dermatology and women's dermatology.

    Her husband is a deal advisory partner of a Big Four accounting firm. They have a six-year-old son and a five-year-old daughter.

Q The challenging cases I face in Singapore are...

A Mostly eczema cases. As it is easy and affordable for patients and their parents to access healthcare here, they will normally go round seeking opinions from various doctors and traditional physicians as well as alternative practitioners. However, it means that healthcare professionals will not be able to get to know their patients well enough to build rapport, and recommend treatments that suit them and their lifestyles.

Q The mistakes that eczema patients often make is...

A To refuse to use steroid cream. To manage eczema flare-up, dermatologists quite often recommend topical steroid and moisturiser. However, many patients or their parents will not comply with the recommended treatment as they fear the steroid cream will harm them.

As a result, the recurrence of flare-ups is so frequent, causing one to think that they are addicted to steroid. Topical steroid is still far safer if used appropriately compared to oral steroid, oral antibiotics or any other oral immunosuppressants.

Patients may feel they are better off taking oral medication, which they usually refer to as oral anti-histamines, rather than use a topical steroid.

But topical steroid remains the mainstay of treatment. An oral antihistamine works differently on the skin: It will temporarily relieve the itch without addressing the underlying skin inflammation.

Q A typical day for me would be...

A One that starts with getting myself and my children ready for a long day ahead.

I work at three sites - predominantly in the skin and aesthetics centre at Raffles Holland V, followed by the same specialist centre in Raffles Hospital, and then at KK Women's and Children's Hospital which I visit once per week to run the paediatric dermatology and vulva clinics.

My children go for lessons in the evenings on weekdays and the weekends are when we can spend quality time and do fun activities together as a family.

Q One little known fact about dermatology is...

A That dermatologists may not always give you the perfect diagnoses at the first consultation.

Paediatric and genital skin-related cases are always a challenge for us because these skin conditions evolve as the child grows and the nature of genital skin (that is, the mucosal surfaces) may mask the underlying skin conditions.

Hence, it is important for families and patients to stick to one doctor whom they are comfortable with so that the doctor can closely monitor the progression of the skin condition.

Q Patients who get my goat are...

A Those who see many doctors for the same skin condition.

As there is no continuity of care and perhaps a lack of information on previous investigations and treatments, physicians will not be able to monitor the progress and response to treatments rendered.

Q Things that put a smile on my face are...

A Witnessing the improvement of patients' skin conditions as well as their quality of life after making the right diagnosis and recommending the best treatments available.

Q It breaks my heart when...

A Patients or their parents choose not to listen to their doctors' advice.

If I think that their previous doctors have done what is necessary for them (even though it may not be what they want), I would take time to explain why it is good for them. I do this in the hope that they will understand the logic behind every recommended treatment.

Q My best tip is...

A To apply moisturiser and sunscreen daily. Prevention is always better than cure.

For example, sun spots on the face are not easy to treat, and laser treatment is not the magic solution to all pigmentation problems.

Although there are medical treatments for sun spots, one must never forget sunscreen to prevent the worsening or recurrence of sun spots. Start young and remember that it is never too late to adopt this habit.

Q I wouldn't trade places for the world because...

A I am in a position where I can help my patients improve their quality of life, especially those who have been stricken by severe skin conditions. And the joy of seeing them recover is priceless.

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A version of this article appeared in the print edition of The Straits Times on February 20, 2018, with the headline 'Why this doc hates it when patients doc-hop'. Subscribe