The Surgeon’s Cap Bias

The Surgeon’s Cap Bias: Intelligence, Respect and the Enemy of Feminism By Emily Haque, BSA* Tags: feminism, gender bias, implicit bias, surgery, women in medicine On the first day of my surgical clerkship, I briskly followed my attending, a vascular surgeon, around the pre-op bay while ruminating about whether or not I was too close to him, if I should stand, if I should sit, if I should put my hair up or leave it down, or even if I should ask him a question. As he towered over me, I decided to keep quiet and avoid bothering him at all costs. I didn’t know why I was so intimidated … Continue reading

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American Mohs: A Critical Review

Authors: Brett M. Will1, David J. Elpern2 MD; Roy Grekin3, MD; Douglas W. Johnson4, MD Affiliations: 1 Medical Student, Georgetown University School of Medicine, Washington, DC; 2Practicing Clinical Dermatologist, Williamstown, Massachusetts; 3Department of Dermatology, Clinical Professor, University of California San Francisco School of Medicine, San Francisco, California; 4Department of Dermatology, The Queen’s Medical Center, Honolulu, HI Keywords: Mohs Surgery, Health Care Costs, History of Medicine, Practice Guidelines as a Topic, Skin Neoplasms Abstract Over 80 years ago, a medical student conceived of a novel approach to remove difficult-to-treat nonmelanoma skin cancers. The procedure, called Mohs Micrographic Surgery (MMS), has been refined over the ensuing years and now large numbers of … Continue reading

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Implicit Bias in Medicine: Case Report and Literature Review

by Kory M. Johnson, Emma Fixen, David J. Elpern, Douglas W. Johnson Mount Sinai Health System, New York, NY John A. Burns School of Medicine, PGY1, Honolulu, HI David Elpern MD: The Skin Clinic, Williamstown, MA University of Hawaii School of Medicine, Honolulu, HI Keywords: implicit bias, explicit bias, immigrant, indigent, psoriasis, lymphoma, healthcare A 46-year-old Micronesian woman with history of severe disabling psoriasis and psoriatic arthritis had been our patient for many years (Figures 1 and 2). Her psoriasis started as an adolescent and had been treated with numerous therapies including topical steroids, phototherapy (sunlight exposure in Micronesia), methotrexate, cyclosporine, acitretin, apremilast, etanercept, infliximab, ustekinumab, secukinumab, ixekizumab, IL-23 blocker, … Continue reading

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The Melanoma Epidemic: Reflections on a Creature We Have Made

In the end, we are dependent on the creatures we have made. Goethe By David J. Elpern Abstract: I believe that the current melanoma epidemic is mostly an artifact of aggressive promotion by dermatologists, dermatopathologists and oncologists. For decades the death rate from melanoma has stayed constant, while the rate of diagnosis has soared. Promoted screenings, diagnostic drift, and the dermatoscope are causing physicians to pick up indolent lesions that are unlikely to kill. These, in turn, cause unwarranted, anxiety in the public and providers. When the dermatological establishment started the war on melanoma in the 1980s it had no idea where it would lead and at present we are … Continue reading

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Preprint Opportunities: Dermatology and Medical Humanities

Preprints and Post-Publication Peer Review by David J. Elpern We are creating two Preprint Repositories that will help some authors. dermatolRxiv.com and medhumRxiv are free online archives for finished but unpublished manuscripts (preprints) in dermatology and the medical humanities. Preprints are preliminary reports of works that have not been certified by peer review.1 The so-called major dermatology journals are the domain of academic dermatologists, some of who are bedfellows of pharmaceutical companies (PhRMA).   These major American dermatology journals, in particular, are heavily dependent on lucrative PhRMA ads. We envision dermatolRxiv.com and medhumRxiv as resources for clinical dermatologists and others who are not vassals of PhRMA or academic medicine to publish … Continue reading

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