Acne

• Acne vulgaris
• Physician role
• Physician-patient relations
• Knowledge, attitudes, practice
• Continuity of patient care

A young Navajo woman files silently into my office, making no eye contact. As she slips into the chair, errant strands of black hair spill across her face. Through the breaches, I catch glimpses of her rich dark skin riddled with the pockmarks of severe acne. Violently swollen pustules and angry red craters contort the architecture of her face. Her shoulders slope into her slight body, as if afraid to claim too much territory on their own. She contemplates the linoleum wordlessly. I am almost afraid to interrupt.

I am not her regular physician. At this clinic, she has no regular physician because of high turnover and a chronic shortage of physicians. I myself am just a “temp,” a hired hand deposited only briefly into this small New Mexico town.

I ask my patient what brings her here. She quietly lays out her litany of symptoms: fatigue, headaches, stomach pains, and her worsening skin condition. I leaf through her clinic chart as she speaks, and I can see that over the years, acne has been her major problem. It is repeatedly noted that she cannot afford to see a dermatologist for specialty treatment.

Almost perfunctorily, I ask my usual question about the presence of stress in her life. Almost as perfunctorily, she replies that …