Category Archives: Elpern, David J.

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. Start stock trading with Finxo’s trend guide. stock trends . Grow your portfolio fast. 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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Hot Spots in Dermatology 2018 Syllabus

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August 17 – 19, 2018 Turtle Bay Resort Kahuku, Hawaii   Thursday, August 16: 6:00 pm.  Get together at The Johnson’s Cabana 6:00 Friday, August 17: 8:00 am Registration and Breakfast 8:30 a.m. – 12:30 p.m.  Plenary Sessions 8:30 – 9:20 a.m.  Clinical Pathological Cases (Marianna Karewicz, Kumar, Rademaker, and others) 9:20 – 9:30 Michael Webster. Radiotherapy Update 2018 9:30 – 10:00: Marius Rademaker.  “How I use isotretinoin” 10:00 – 10:30 Bhushan Kumar. “Non-venereal genital dermatoses” 10:30 – 10:45 Refreshment Break 10:45 – 11:15  Malcolm Ing. “Dr.Edmund  Ing: Expertise and Community Service In Hawaii” 11:15 – 11:45  Alan Katz “Antibiotic resistant N. gonorrhoeae: an urgent public health threat.” 11:45 – … Continue reading →

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The Differential Diagnosis of Dermatological Conditions in Relation to Leprosy

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Presented by Professor Bhushan Kumar Former Chief of Dermatology at the Postgraduate Institute of Medical Education and Research, Chandigarh, India Hot Spots in Dermatology August 17 – 19, 2018 Abstract: Leprosy, now an uncommon disease of low infectivity is caused by Mycobacterium leprae. It is rare in the western world and is mostly seen in immigrants from endemic areas. It affects mainly the skin and the nerves. The cutaneous lesions vary widely from macular to papular, papulo-nodular and nodulo-plaques covering large areas of the body. So the dermatological diseases which need to be differentiated vary widely, having lesions which may resemble any of these morphological lesions. Occurrence of lepra reactions … Continue reading →

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Non-Venereal Genital Dermatoses in Men

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Presented by Professor Bhushan Kumar Former Chief of Dermatology at the Postgraduate Institute of Medical Education and Research, Chandigarh, India Hot Spots in Dermatology August 17 – 19, 2018 Abstract: Lesions on the genitalia either alone or as part of the general disease are common dermatological presentations. Majority of the lesions are non-venereal and are of great concern patients because of the importance of the “organ” involved. In addition the disease may bring in feelings of guilt, being unclean, related to STD and may even lead to marital discord. The lesions may only be physiological or benign abnormalities, inflammatory in nature, infections or part of the systemic disease. Only few diseases … Continue reading →

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