Notes on Pathographies

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

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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

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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

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Health Anxiety in Dermatology

Patients see doctors with varying degrees of concern regarding their health. While some require tests or treatments, a subset has severe health anxiety and cannot be reassured by tests, procedures, or pharmaceuticals but may be helped, at least temporarily, by a sympathetic listening face and reassurance. Hence, we designed a questionnaire to investigate health anxiety in patients recruited from a general dermatology clinic. The study was reported in the International Journal of Dermatology and can be accessed at this pdf: Health Anxiety in Dermatology

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MUDS: In Search of Medically Unexplained Dermatological Symptoms

by David J. Elpern, M.D. Medically unexplained symptoms (MUS) are relatively well-known in the literature but not discussed in any dermatology journal. A recent book, Is It All In Your Head?: True Stories of Imaginary Illness, by by the neurologist Suzanne O”Sullivan is a readable and accessible resource. While studied in primary care, neurology and rheumatology, our PubMed review found no mention of medically unexplained symptoms in a major dermatology journal. Yet two surveys conducted in my office, each of of 100 consecutive dermatology clinic patients, found that ~ 20% had some form of MUDS. This rate is congruent with the estimated prevalence of MUS.  It appears that MUDS are … Continue reading

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Spirituality in Dermatology

by Jorge Ramon and David J. Elpern This article was published in the July 2017 Archives of Dermatology Excerpts: Spirituality is difficult to define, but a recent consensus conference defined it as the aspect of humanity that refers to the way individuals seek and express meaning and purpose. Spirituality is understood by many as a means by which one copes with chronic or life threatening illnesses. While some people may not believe in a specific faith, many are interested in spirituality. Coming to grips with each individual patient’s spirituality requires a broad understanding of the person’s beliefs and values. Christina Puchalski’s FICA Spirituality History Tool1 can be a guide to … Continue reading

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Towards Continuous ‘Medical’ Inspiration

by David J. Elpern, M.D. Abstract: Physicians waste too much time mired in our pedantic and mediocre professional literature. There is no way one can keep up with it and most of the articles are forgettable and sadly will prove to be inaccurate. It is better to spend time with the arts (literature, music, fine art, film) that are more important to one’s personal and professional development. They provide the Continuous Medical Inspiration that trumps Continuing Medical Education. Keywords: medical education, canon, personal canon, literature, fine art, music, William Osler, medical literature, CME Each week physicians and other caregivers peruse their professional literature.   We also gather regularly at Grand Rounds … Continue reading

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Isotretinoin on a Global Scale

In the end, we are dependent on creatures we have made. Goethe  Isotretinoin and iPledge  on the Global Stage by Ava Atri, B.A. and David J. Elpern, M.D. Keywords: isotretinoin, regulation, iPledge program, teratogen Introduction Isotretinoin has revolutionized the treatment of acne since it was approved by the U.S. Federal Drug Administration in 1982. Because it is teratogenic, some countries rigorously regulate its prescriptions.  In the United States, prescribers and patients must comply with the iPledge Program in order to write or fill isotretinoin prescriptions.1  A chance discussion with a colleague from Iran, where isotretinoin can now be purchased without a prescription, led us to survey a number of other … Continue reading

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