If good things really do come in threes then it’s clear how leading dermatologist Amanda Oakley would like to complete her career trifecta, after recently becoming a Companion of the New Zealand Order of Merit and an Honorary Fellow of the College.
With some of the world’s highest levels of skin cancer and one of the lowest dermatologist to patient ratios, New Zealand must get serious about tackling an epidemic that is likely to get worse before it gets better, she says.
“We need more dermatologists, a better understanding of skin among our GPs and to further harness technology to improve how we diagnose skin conditions and cancers.”
Dr Oakley is active on all these fronts, particularly through the dermoscopy workshops she runs for primary care providers nationwide, suspected skin cancer teledermatology eReferrals in the Waikato region and the DermNet NZ website that she created in 1995 and has managed ever since.
Today the site is regarded as the world’s most popular online resource for skin health, with about 2,500 pages of dermatological information accessed by doctors, patients and their families, students, librarians, pharmacists, pharmacologists and drug companies.
Now in her 40th year of living in New Zealand – after graduating in the UK and travelling to Waikato for what was intended to be a 12-month working holiday – the University of Auckland adjunct associate professor adds: “Technology can’t solve all our problems, but it certainly has a role to play.
“If you live in certain parts of New Zealand you might have to drive several hours and fork out several hundred dollars for the privilege of seeing a dermatologist. Technology can help make some of these trips unnecessary, for example by immediately identifying benign cancers.
“A PhD student I was helping in early 2017 had a vision of people walking into a booth in a shopping mall, having a picture taken of their skin lesion and then being told by the machine whether they need to see a doctor, or if it’s nothing to worry about.
“We’re not quite there yet but I think we’re getting closer.”
As Dr Oakley moves closer to retirement, she is showing no signs of slowing down. She is as passionate as ever about dermatology and a strong advocate of its importance in health training.
She says: “Medical students are routinely taught to use stethoscopes, ophthalmoscopes and otoscopes but we should also be teaching them more about skin and how to use a dermatoscope.
“Our biggest problem is there are very few dermatologists in New Zealand. There are only a few in the public sector and an increasing number of people with skin diseases will never get to see one.
“Right now dermatology is only covered in the fourth year of medical school, in a couple of two-hour tutorials. The students also attend a dermatology clinic - where they might see lots of good examples, or they might see very little.
“We don’t have enough people with the right knowledge - it feels a little like the blind leading the blind.”
Dr Oakley’s beliefs are echoed in a Dermatology Workforce Service Forecast released in late 2014 by Health Workforce New Zealand.
The report states: ‘It is clear that public dermatology in New Zealand is very under-resourced not only in terms of the workforce, but also in the range of services and treatment options available.
“The service needs to expand to address current unmet need, long waiting lists and predicted increased demand.
“Improving GPs’ competency and knowledge of dermatological conditions and treatments should result in reduced referrals. In addition, it will improve the quality of consultations and advice given to patients.
“Today we only have five dermatology trainee positions in the whole of NZ,” adds Dr Oakley.
“How do we attract people into dermatology when they have not really been exposed to it during their training? They quickly forget the short dermatology sessions they received in medical school.
“Funding more positions is not a priority in this country. But people are living longer and having more skin diseases. They are also getting larger, with more cases of diabetes - which is also a contributor to skin conditions.”
Those attending the College's annual conference in Auckland will be able to meet Dr Oakley, who is looking forward to accepting her Honorary Fellowship on Saturday 28 July.
“It is an enormous honour to receive an Honorary Fellowship from the College,” she says. “It’s very meaningful for me because I have devoted a lot of my career to supporting primary care in all aspects of dermatology.”