Category Archives: Elpern, David J.

Body Dysmorphic Disorder in Dermatology

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        by Elizabeth Cook* Keywords: Body dysmorphic disorder, cosmetic dermatology, cosmetic surgery, screening, surgery We all know someone who sees a different reality in the mirror. We try to convince her that she is beautiful. “No one is staring,” you say. “Your nose looks just fine.” She may point to her cheek and demand confirmation of invisible flaws. I say she because body dysmorphic disorder (BDD) favors women. Like eating disorders, it usually begins in adolescences, but unlike eating disorders the focus is on minimally noticed or imagined defects, not on fat. By the time these women reach adulthood, they end up in the dermatology clinic, seeking … Continue reading →

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Why Nothing Works

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More humanism and less science, that’s what medicine needs. But humanism is hard work, and so much of science is just Tinkertoy. Robertson Davies Why Nothing Works An Introduction to the Placebo New York Times, November 11, 2018 I have been interested in the placebo response for many years. This recent NY Times article is a good introduction to the topic. Here are some excerpts and random thoughts: The author, Gary Greenberg, attended the Society for Interdisciplinary Placebo Studies in Leiden, Holland (2017). He met some key researchers in placebo there. There is a conviction among many that the placebo is a powerful medical treatment that is ignored by doctors … Continue reading →

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Thoughts on Gawande’s “The Upgrade”

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In the end, we are dependent upon the creatures we have made. Goethe The Upgrade (Full New Yorker Text) Why Doctor’s Hate Computers by Atul Gawande The New Yorker, November 12, 2018 Gawande’s thesis is that the electronic medical record (EMR) has contributed greatly to the epidemic of physician burnout in the United States. A 2016 study found that physicians spend about two hours doing computer work for every hour spent face to face with a patient. The result has been epidemic levels of burnout among clinicians. Something has gone terribly wrong. The software created for the EMR has spawned this massive monster of incomprehensibility. So much of what physicians … Continue reading →

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On Infomercials and Experimercials

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Dr. Bernard J. Carroll, an academic psychiatrist, died on September 10, 2018. His work demonstrated that the psychiatric drug literature had become so polluted as to be virtually meaningless, He called most drug trials “infomercials.” See his NY Times Obituary. Over the years, I have observed in my specialty, dermatology, the same is true. The Biologics are being aggressively and venally marketed. The result is that Humira, with sales of $18.5 billion in 2017, is the top selling drug in the world thanks to AbbVie’s multi-pronged marketing strategy. Where are the other Dr. Carrolls in medicine? Does dermatology have one? So many of our academic “stars” have been co-opted and feed … Continue reading →

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Medically Unexplained Dermatologic Symptoms (MUDS): Hiding in plain sight?

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By David J. Elpern, M.D. J Eur Acad Dermatol Venereol. 2018 Jul;32(7):e265-e266 Keywords: medically unexplained symptoms, somatoform disorders, symptoms, illness, disease Illness is not the same as disease. Illness refers to “the innately human experience of symptoms and suffering.”1 Disease “is what the practitioner creates in recasting illness in terms of theories of disorder.” A person’s subjective experience of how she feels may not assume an underlying pathology. Illness can be organic, psychological or spiritual. A person can feel ill, but not have a disease. Consider Sara (not her real name), a 31-year-old social worker who sought dermatological care for a seven-year history of painful vulvodynia and generalized pruritus. Her … Continue reading →

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My Illness Narrative: the Autopathography Project

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You may have a complex health problem that doctors have not solved. When you enter a new doctor’s office, a perky young person at the reception area asks who referred you and then requests your insurance cards. Next, you will be given numerous forms to fill out. Then you are seen by an assistant who records your weight, blood pressure, pulse, and even the oxygen saturation from a fingertip. Finally, the physician or his “extender” sees you for 10 – 15 minutes, at least half of which time he is focused on your electronic medical record. After this ceremony, what does the medical professional know about whom you are and … Continue reading →

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What Matters to Me: Investigations in a Dermatology Practice

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Nothing about me without me.  What Matters to Me: Investigations in a Dermatology Practice By Hope Mendez and David Elpern, M.D. The Skin Clinic, 12 Meadow St. Williamstown, MA 01267 Corresponding author: David Elpern djelpern@gmail.com Abstract: We surveyed 125 consecutive patients in a dermatology clinic in rural Massachusetts in the attempt to learn what matters most to them in their interactions with providers and the health care system. Keywords: patient-doctor communication, patients’ rights Introduction: We were first made aware of to this subject by a prescient article in the British Medical Journal by Sosena Kebede.1 When patients see providers they are rarely given the opportunity to communicate what they they … Continue reading →

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Delusions of Infestation/Morgellons

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Presented at Hot Spots in Dermatologgy Kahuku, Hawaii August 18, 2018 by Lauren Claypoole, MS1, John A Burns School of Medicine (University of Hawaii) My presentation is called “Delusions of Parasitosis/Morgellons>  When I was at college, I was able to shadow a dermatologist for a month. He suggested I present two once-in-a-blue-moon cases that I observed at the clinic. Both patients taught me about the intricate crossover between the fields of dermatology and psychiatry, that I believe contributed significantly to my choice to be a psychology and neuroscience major shortly thereafter. Full Talk: Delusions of Parasitosis/Morgellons

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Hot Spots Presentations

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    Kahuku, Hawaii August 17 – 19, 2018 Presentations in Alpha order by Speaker Where Column # 4 has a “Y” the handout is at www.ojcpcd.com Bintliff, Shay surfdoc@aloha.net On Retirement Y Claypoole, Lauren claypoole.lauren@gmail.com A Student’s Introduction to Delusional Parasitosis Dann, Frank zitdoc@hotmail.com As I’ve Seen it over Four Decades Elpern, Dave djelpern@gmail.com Who Was Michael Balint? Y Esaki, Paul paulesaki@gmail.com Flying solo with a complex patient Glamb, Roman rglamb@straub.net Paraneoplastic Pemphigus a Platform to Bloviate Goo, Alana alanagoo@hawaii.edu Flying solo with a complex patient Ing, Malcolm malcolmingmd@hotmail.com Dr.Edmund  Ing: Expertise and Community Service In Hawaii Y Johnson, Douglas dwj808@gmail.com Western Samoa, 2018 Johnson, Evan ewjohn127@gmail.com Navigating the … Continue reading →

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