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I’m still doing some online research to figure out where to seek treatment for severe acne but I’m a bit overwhelmed by the profusion of dermatology/aesthetic centers here and the wide-ranging prices. I’ve decided that I will only seek treatment with a medical doctor but It still really does sound like one would benefit from word of mouth in Singapore.
I’ve noticed that some skin doctors have the FAMS designation whereas others don’t. Is this like a board certification in the doctor’s specialty (in this case dermatology)? In your professional opinion, do you think it makes a difference when it comes to treating a condition like severe acne, considering they might recommend potentially operator-dependent procedures like laser treatments? Or would a doctor (without FAMS) who’s had many years experience with the procedure(s) be comparable to an experienced person with the FAMS designation? I realize this may be a difficult question to answer but your opinion is appreciated.
Thanks Dr Ethan for your answer. As a person who went through acne myself in younger days, I had actually gone to NSC myself as a patient.
I was started on doxycycline, and kept on it for ages as I continued to outbreak and scar.
Albeit the dermatologist was an immensely qualified one, but one whom I felt didn’t take the next step for Isotretinoin, which would have benefited me.
Fast forward – I gave up and ended up going to a GP and asking for Isotretinoin, and he kindly explained what it was useful for. Acne gone!
As for a professional front in dealing with my own patients, I had a patient who had immensely bad chest acne, who saw a highly regarded dermatologist. He was started on an insanely high Accutane dosage with no improvement.
It took me five minutes of questioning to find out he frequently waxes his chest. I instructed him to hold that off, as thermal injury and ingrown hair was the likely cause, and also dropped his Accutane to 20 percent of the initial dose. His acne is now gone, and he is happily accepting my advice on other aspects.
Basically, don’t be fixated on just the qualifications. Find someone who is willing to sit through and talk to you about your issues, and work through it. I feel that’s key. Establish the trust and all will be fine!
Dr Winston Lee
Great question. Some of my answers below will be factual, and some will be personal opinions. Sorry for the verbose answer, as I hope that it will help other readers too.
Fact: All doctors with FAMS are specialists, but not all specialists have FAMS.
You need to first be a specialist, before applying to be a Fellow of the Academy of Medicine. Think of it like an exclusive members club, for specialists in Singapore. It is not a board certification, as they would have completed their “board specialty exams” by then.
The criteria to become a Fellow (taken from their website) are as follows:
- Have successfully completed an advanced specialty programme approved by the Academy for purposes of Fellowship admission or is in a specialty or subspecialty recognised by the Specialist Accreditation Board; and
- Are of good general character and conduct, as testified by three referees who are Fellows of the Academy of Medicine, Singapore.
Almost all specialists invariably apply to become a Fellow upon completion of their specialty training. I actually can’t recall the last time I came across a specialist without FAMS.
I think you may be confused by aesthetic doctors/GPs with an interest in skin, some of who go on to take diplomas in dermatology. This does not equate to being a dermatologist/skin specialist, who spend much longer training to diagnose and treat skin disease.
Now having said that, you raise a good point – do professional qualifications/specialty training or experience/professional interests count for more?
This is where I weigh in with some personal opinion, based on anecdotal experience.
A long time ago during my pimply JC days, I had a chastening experience with a particular dermatologist (still practising today) who was highly recommended on local online forums. She was curt, impatient, and totally disinterested with any of my questions during my first, and last visit.
Was she knowledgeable, experienced, and super qualified to treat acne? Undoubtedly so. Did I feel that she was the best person to help me with the issue? A resounding no, which is what drove me to write a PSA post over a decade later recommending (a very non-exhaustive list of) friendly dermatologists in Singapore whom I’d refer my own friends and family to.
On the other hand, I also know of GPs and Family Physicians who are passionate about treating acne, and have accumulated over 20 years of experience seeing acne patients. They get their patients to come in with every single acne topical and soap product they use, and take the time to patiently tell them which to continue with, and which to stop; even going so far as to test newer acne products on themselves.
My take, if I were in your position?
- I’d pick the friendliest dermatologist I can find through a reliable word of mouth reference (ask a doctor friend), with a special interest in treating acne.
- A friendly GP/aesthetic doctor with a special interest in treating acne would be the next best option.
As a member of public, it can sometimes be really hit or miss with choosing a doctor. Before joining the medical profession, I myself went through 5 – 6 “misses” with different doctors (both dermatologists and popular “acne clinics” run by GPs), all of whom were highly recommended by friends, family, or online forums.
Some red flags from personal experience would be:
- A doctor who insists that X or Y is the best/only way to treat acne, without taking the time to explore other treatment options with you
- And/or one who makes you buy and use only his range of branded special acne washes and creams, without explaining the ingredients in them that make them effective
In answer to your final query, I’d concur with you that when it comes to operator-dependent procedural treatments (like lasers), accumulative experience certainly counts.
Having said that, the treatment algorithm for acne, be it mild, moderate, or severe is relatively straightforward, and do not involve lasers. If your acne is severe and scarring/at risk of scarring, most doctors would want to start you off with Accutane (isotretinoin).
TLDR: Any doctor is able to treat acne, but some will be less interested/invested with putting more time into following you up closely, and tailoring treatment to best manage your condition. Get a word of mouth recommendation from a doctor friend.