By Daniel M. Siegel, MD, January 01, 2013
When 2030 arrives, chances are my knowledge of what happens day-to-day in the nation’s dermatology practices will be limited to what I read in Dermatology World or download to the chip that will, by then, be implanted in my optic cortex. As we will surely have figured out a way to use stem cells for all sorts of reparative procedures, I will be youthful, active, and skinny.
Some days I might communicate with patients using holographic cameras from home or wherever I may be, while other days will find me in the office with a panoply of new toys to play with. I imagine a future where we can offer patients non-invasive biopsies, a combination of optical technologies just finding their roles today augmented by chromatographic devices that can sniff out melanoma better than Dr. Cognetta’s dog. New diagnostic tools may allow us to differentiate the mundane from the malignant without all the waiting. No more biologics that hit intended targeted receptors along with hundreds of other binding sites that cause mischief. Instead, targeted therapies, prescribed for patients based on their unique genetics, will provide better results with fewer side effects.
With all of this change, what will remain the same? I hope that, from my self-driving solar-powered hovercraft, I am still reading about the feats and discoveries of the dermatology residents I’ve helped train, and of the incoming residents they will train. I hope that these new generations of dermatologists are still at the helm of an ever-growing care team, ensuring that patients receive the full benefit of our training and expertise regardless of the dominant care model or most popular treatment modalities of the day.[pagebreak]
What will we, as dermatologists, have to do to make this vision a reality? Preserving our place at the head of the team that cares for patients’ skin, hair, and nails will require us to maintain and increase our engagement in our communities. It will involve extending our relationships within the house of medicine. This may mean giving lectures or taking call at the hospital to build a relationship there. It may mean embracing new ways of providing consultations with primary care providers as part of emerging care models. (You can leap on this bandwagon today. Give your local hospital a digital camera and see their teleconsults now!) It may mean participating in your county or state medical society. Preserving our place may also mean getting involved, or more involved, in the political process at the state or local level, and participating in calls to action from the AADA and its political action committee, SkinPAC.
Of course, to maintain our place at the helm, we have to remain the people with the best, most up-to-date knowledge of the latest and greatest in our field. That means keeping current in our reading, of course, whether we’re reviewing JAAD in print, using its new app, or downloading to that embedded chip that lets you have access to a few terabytes of the Web offline. It also means coming to the Academy’s annual and summer meetings, engaging with the latest findings, and looking for ways to incorporate them into the care we each provide back home. I’m convinced that while many things work virtually — even, in some cases, teledermatology — nothing will replace gathering with thousands of our colleagues in one place, where breaking bread with friends in the flesh will always be as enjoyable as it is now.
To be trusted at the top, we’ll also have to ensure that our staffs, including the physician assistants, nurse practitioners, and other paraprofessionals yet to be defined who will work with us to provide patient care, have excellent training and skills. That’s why your Academy is grappling with the best way to ensure that the continuing education these allied health professionals receive meets the needs of both you, their employers, and of patients. We must work to find the right balance that gives these partners in care the tools they need to do the best possible job; after all, what they do reflects on us. But we have to do so in a way that ensures that we, the ones with medical school and a residency under our belts, are making the tough calls and the final decisions.