By Abby Van Voorhees, MD, August 03, 2015
It probably won't surprise you to learn that I am a people person. Maybe it was because I grew up as a middle child, or my genetic make-up, but evaluations of me from the time I was in nursery school to the present day are always similar. As an affable four-year-old they basically stated that I “played well with others.” Want to play in the sand box? Okay with me so long as friends were going to be there.
Generally speaking we dermatologists do play well with others. It’s why we get a kick out of talking to our patients. For many of us, it is why we went into health care to begin with. However, in the playground of medicine there are some “big kids” that don’t necessarily play that way.
For much of my career, we in dermatology have been regularly irked by the “big kids” in the rest of the house of medicine. We viewed them as biting at our feet, trying to cut into our turf, and not appreciating our talents and needs. It didn’t help that the other branches of medicine were, in almost all cases, bigger and stronger than us, and therefore could be truly formidable adversaries. However, the issues we face in medicine now are ever more challenging. Our leadership has recognized this and has engaged the rest of medicine; we are reaping the benefits. We write this month about dermatology’s recent successes that have emerged from this collaboration. The most obvious is the SGR repeal, but this is only one of many. Working with others has helped us in the areas of narrowing networks, formulary transparency, patient safety, and telemedicine, to name a few. Getting others to see things our way is not always successful, and having the wisdom to know when to bend and when to stand alone is key, but working within the house of medicine has been a fairly fruitful path of late. So while we in derm need to remain steadfast, for example, in our commitment to fight pathology’s intrusion into our ability to read our slides or in our right to perform office-based surgery, it makes sense to me that joining with others is here to stay. Maybe it is time for many of us, myself included, to reconsider supporting the AMA as the next step...then our seat at the table would be even stronger.
The over-usage of antibiotics is a national public health concern, and it is having an impact in dermatology. We write about the need to change the acne paradigm in this month’s issue. Resistance to tetracycline antibiotics has grown hugely. When I was a resident we were predicting that these medications would become less useful as resistance developed like it had with erythromycin, but we kept prescribing anyway. I think that we were convinced that antibiotics were still the safest and most effective option for the patient in front of us. However, the new acne guidelines, which are about to be published, will shift this treatment paradigm for our patients. While oral antibiotics will not go away, hormonal therapies such as spironolactone and OCPs have become increasingly important. You’ll also want to read about the need to get patients using topicals such as tretinoin, dapsone, and benzoyl peroxide for maintenance therapy to prevent further antibiotic resistance. It is a big deal when one of our most common diseases shifts its recommendations for care. Benzoyl peroxide, I guess, just plays well with others, and that is a paradigm that I find easy to embrace. Granted: I like things that way.
Wish I had more space to highlight some other pieces in this month’s magazine — wrong-site surgery is a must-read as is the one on how to create a patient-friendly bill. Too little time and space for my musings, but trust that you will enjoy your reading.