Notes on Pathographies: An Arabian Nights’ Experience David J. Elpern* * The Skin Clinic, Williamstown, Massachusetts Email A few years ago, a group of us gathered in the Osler Library at McGill. Osler guided us with his words: The practice of medicine is an art, not a trade: a calling not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with powders or potions, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, the wise upon the foolish… Courage and cheerfulness … Continue reading
The Soul in the Machine
Keith Wagner, MS – kedwagne@utmb.edu University of Texas Medical Branch at Galveston PDF of Article: Humanism Essay Final-1 Medicine has many facets, but at its heart there is only the patient to be found. The word “patient” is derived from the Latin “patiens,” meaning “I am suffering.” Patients’ collective will to feel well or relieve their burden has spawned every branch on the tree of the health professions. Regardless of their physical or psychosocial ills, they are all souls seeking relief. Patients are not just some complicated machinery to be repaired. They are the spirit hidden inside that machine. You will not find a patient’s love of fishing on UpToDate. … Continue reading
Sentinel Lymph Node (SLN) Decision Aid
The question of whether to undergo a SLN biopsy for melanoma is a difficult one. It is clear that some experts recommend it while others don’t. If you live in Boston you will be told one thing. If you live in Montreal you’ll be told another. Where does that leave a patient? In England the National Institute for Clinical Excellence (NICE) provides decision aids for many conditions. Here is their SLN Decision Aid for melanoma. Please give it thought and discuss it with your dermatologist or surgeon. The decision is really up to you. It boils down to “What Matters To You.” Option-Grid-Sentinel-Node-Biopsy-yes-or-no
To JR – whoever you are
by Jon Karnes, M.D. I stumbled across a negative review of myself by a patient scheduled to see me on a day I had a family emergency. It got under my skin and, for whatever reason, in response I started writing. The following poem is what came out of it. It has been therapeutic and I’m happy to share it with you. JR–Whoever you are We actually have a lot in common When you gave me that one star and lumped me together with Starbucks, Sam’s Club, and the United States Post Office — “it is only Doctors that get away with making an appointment with clients and then routinely … Continue reading
Cry the Beloved Specialty
by David J. Elpern, M.D. presented in shorter form at the Lown Institute Conference, Washington, D.C. April 9. 2018 Every peddler praises his needles. Portuguese proverb In November 2017, the NY Times published an expose about the current state of dermatology.1 It documented bizarre instances of over-diagnosis and over-treatment that are driven by ignorance and greed. Over the past 40 years, I have witnessed these changes in my specialty and am dismayed by the reluctance of my colleagues to address them. This trend began in the early 1980s when the Academy of Dermatology (AAD) assessed its members over 2 million dollars to hire a prominent New York advertising agency to … Continue reading
Fake Skin Diseases Online: a Review of Dermatological Hoaxes
Warning: The following article may induce nausea and nightmares! Fake Skin Diseases Online: a Review of Dermatological Hoaxes Keith D. Wagner, M.S. Department of Dermatology University of Texas Medical Branch Julie A. Croley, M.D Department of Dermatology University of Texas Medical Branch Corresponding Author: Keith D. Wagner Department of Dermatology 301 University Bvld Galveston, TX 77555-0783 kedwagne@utmb.edu> Abstract The internet has become a fixture of modern times. However, not all the information it holds is accurate. For more than a decade, users have shared images intended to shock. Some have even gone so far as to create fake skin conditions using photo-editing programs or other means. We present six “skin conditions” … Continue reading
Thoughts about “Countering Creeping Confusion”
by Richard Ratzan, M.D. Dr. Ratzan was a Classics major at Trinity College whose early publication as a medical student was on the Greek word for herpes (see reference # 8 in his attached letter). THE EDITOR kindly asked me to comment on an unusual paper suggesting we rename Herpes virus “Habita virus”, a paper imaginatively conceived, adroitly executed and very well written.[^1] In it, the authors evince four reasons to support their suggestion: lack of congruence between the etymological history of “herpes” and its dermatological appearance; sociological and psychological stigma; potential confusion concerning first the different herpetic diseases and second an unrelated virus, Hepeviridae, a virus associated with diseases … Continue reading
Countering Creeping Confusion: A Proposal to Re-Name Herpes Virus TAXONOMY
Curing Contagious Confusion: It Is Time to Re-Name Herpesviridae Countering Creeping Confusion: A Proposal to Re-Name Herpes Virus TAXONOMY Vail Reese, MD1, Julie A. Croley, MD2, Richard F. Wagner, Jr., MD2 Affiliations: 1 Union Square Dermatology, San Francisco, CA Assistant Clinical Professor, UC San Francisco 2 University of Texas Medical Branch, Department of Dermatology, Galveston, TX Tags: Viral Taxonomy, Herpes Simplex, Herpes Zoster, Epstein-Barr Virus, Cytomegalovirus, Kaposi’s Sarcoma, HHV, HSV, EBV, Varicella, Habitavirus Corresponding Author Information: Julie Croley, MD University of Texas Medical Branch, Department of Dermatology 301 University Blvd, Galveston, TX 77555 Email: jaamthor@utmb.edu Note: See Dr. Richard Ratzan’s letter about this article: Countering Herpes- A Commentary ABSTRACT : … Continue reading
A Doctor’s Responsibility
Doctors Helping Patients by James Channing Shaw, MD Keywords: Doctor’s Responsibility; Helping Patients; Hippocratic Oath; Physician Charter; Doctor-Patient relationship We diagnose, we treat. We try to do no harm. But what do we do when diagnoses evade us, or treatments fail? Do we physicians have an obligation to keep working with the patient after a diagnosis or cure eludes us? Some doctors might say no, that it’s perfectly acceptable to tell a patient “there’s nothing more I can do for you”; or discharge the patient without answers or directives, rationalizing that “I’ve done my part.” This especially applies to specialists. Patients, on the other hand, expect their doctors to keep … Continue reading
Making All Lives Matter in Medicine
by Michael O. Memsah, M.D. I was in medical school when I learned that I did not matter in medicine. One particular day on service started uneventfully. However, after the team’s discussion of a patient, all attention turned toward me when a senior physician asked me a question about the rap music that had been playing in the background. “Help me understand something:” I recall the physician saying. The physician asked about word choice in rap lyrics, and then, pretending to quote a rap song, repeated the word “nigger” several times in rapid-fire succession. So begins this important “Viewpoint” article in JAMA Internal Medicine. Most of us will benefit from … Continue reading
