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A Conversation With Louis Weatherhead, BSc, MBBS, DABD, FRCPC

A Conversation With Louis Weatherhead, BSc, MBBS, DABD, FRCPC

Louis Weatherhead_headshotDr Weatherhead graduated from the University of the West Indies Faculty of Medical Sciences in Mona, Jamaica. After completing his internship at The Queen Elizabeth Hospital in Bridgetown, Barbados, he pursued a dermatology residency at the University of Ottawa (UOt- tawa) in Ontario, Canada, and received his dermatology specialty certification from the American Board of Dermatology and the Royal College of Physicians and Surgeons of Canada in 1983.

He started his practice in 1984, joining the faculty at the UOttawa and staff at The Ottawa Hospital. He was the consultant dermatologist at the Cancer Centre of the Ottawa Hospital, General Campus, until May 2018. He pursued additional training in surgical dermatology at the University of California, San Diego, and until 2015 was the director of surgical dermatology at UOttawa. His practice is limited to premalignant and malignant skin disease and surgical dermatology, including laser and cosmetic dermatology.

Dr Weatherhead has published several articles, and his research interests are related to malignant melanoma, especially regarding metastatic disease in node-negative cases. His current research pursuits examine the use of gene expression profiling in the prognosis of patients with node-negative melanoma.

He holds a joint appointment at UOttawa as an associate professor in the divisions of dermatology and medical oncology. He is a member of the Ontario Skin Cancers Advisory Committee and is a past president of the Canadian Dermatology Association.

Q. What is the best piece of advice you have received and from whom?
A. There are actually two people who gave me very sage advice, which I try my best to follow every day. The first was my father when I was leaving home to go to university. His advice to me was “Son, you are leaving for a new experience in your life. We do not know where we will end up or what job you will eventually have. All you can do is give it your best in your studies and in your work. Whatever job you may end up doing, always do your best so that people who see what you have done will say that was a job well done. Then you will have succeeded personally.”

The second piece of advice was from my family physician, Dr Will Kerr, who was also a family friend. He encouraged me to study medicine and, when I got into medical school, shared with me these words: “There are always good doctors out there and there will always be those who are better than others. However, a good doctor is one who does the best they can and who can realize when they need help and ask for it. That way you will get the best for your patient as well as learn for the next time you meet that situation.” I hope I have been able to follow that advice as he gave.

Q. What part of your work gives you the most pleasure?
A. I enjoy all aspects of what I do. Every day brings new experiences and twists on what I have seen before. Although my practice is limited to premalignant and malignant skin disease and surgical dermatology, presentations of lesions are often so different and lead to different management plans. When a malignant lesion has been removed and the pathology reports that the margins are clear, that brings great joy to the patient and thus to myself. If combined with that result, there is a good cosmetic outcome, that is a double positive. That brings great personal satisfaction that you have done good for your patient and that really is what it is all about.

Q. Who was your hero/mentor and why?
I wanted to study dermatology in Ottawa at the University of Ottawa Dermatology Program because it was recommended to me when I was a medical student at The University of The West Indies, due to the reputation of Dr Donald Montgomery. In my final year of medical school, I applied to do an elective in Ottawa. I spent 6 weeks there and was absolutely fascinated by the clinical acumen of Dr Montgomery. He had the ability to look at part of a lesion and construct in his mind what  the whole lesion should look like—truly the art of being “visually literate.”

Combined with that, I met his partner, Dr Robert Jackson, another giant of dermatology. I knew this was what I wanted to do for my career. I applied to the Ottawa program and was accepted. I eagerly looked forward to learning from Dr Montgomery and must admit that I was never disappointed during my residency. He was tough but a great teacher, and I hope I have been able to live up to his expectations.

Q. Which patient had the most effect on your work and why?
A. One of my first patients was referred to me almost 36 years ago by her ophthalmologist because of “bothersome skin tags “on her eyelids. When I walked into the room, I knew these were not tags—the lady had Gorlin syndrome. On examination, she had multiple basal cell carcinomas and every clinical feature associated with that syndrome. She was also being followed by several other specialties for other clinical problems associated with her syndrome. I copied my consultation reply to her neurologist and pulmonologist as well. They soon called and it was clear they had no knowledge of this syndrome. So, this one patient was able to educate many different specialists.

I have followed her regularly since that first referral. Over these past 36 years, she has developed a multitude of problems, both cutaneous and extracutaneous. I have learned quite a bit from this patient and have had to deal with many issues; we have had clinical sessions and counselling sessions, especially when her baby son was born with the syndrome as well. I have become this patient’s first stop for questions related to her problems as they have developed. I have learned from her about counseling and helping her to understand her issues, answering questions about suggested therapies and other life issues. She made me realize a long time ago about the need for humanity in medicine and that besides the clinical issues, there are so many other aspects involved in patient care that we as physicians should never lose sight of.

Q. What is the greatest political danger in the field of dermatology?
A. I think today we are facing many issues. Certainly, in Ontario, Canada, and I can only truly speak about where I work, I do not think that the Ministry of Health really understands the depth of what we as dermatologists do. I believe we as a specialty are underfunded. I also believe that our specialty is not truly respected by members of our own medical community. We are often thought to be nothing more than “pimple squeezers” or cosmetic doctors. Many of our younger dermatologists have gone into purely, or largely, cosmetic practices, leaving the care of general and other dermatologic practice to more senior doctors who will be slowing down or retiring in the not too distant future. This does not help our brand.

Also, certainly in the Ottawa region, there are several family doctors who have completed online courses in dermatology to receive a diploma of practical dermatology and who then market themselves and practice as “de facto” dermatologists. This is despite the granting university of this diploma stating that they should not receive consultations in dermatology. The fact that they can practice like this, even after complaints to the licensing body and the Royal College, would make it seem as if the governing bodies do not hold qualified dermatologists, and the program and training needed to attain specialist status, in high regard. The lack of funding for residency programs also has seen shrinkage of residents in training programs. Certainly, in Ottawa, the rate of addition of new dermatologists has not kept up with the loss from retirement or other causes. This has led to a manpower shortage and long wait lists. I fear this situation for other jurisdictions nationally. As a specialty, we need to collectively try to increase our brand recognition and demonstrate our true worth to health care.

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