My Narrow Road through Deep Cyber-space

This road – no one goes down it – autumn evenings. Basho

 PDF for easier reading: The Narrow Road Through Cyber-Medicine

Abstract: This essay describes a 25-year medical odyssey through the universe of cyberspace. It chronicles the author’s adventures with teledermatology, the medical humanities and the online medical literature. The explorations continue but the author does not know the next ports-of-call. He can only “hope the voyage is a long one,/full of adventure, full of discovery.”1Keywords: cybermedicine, blogs, pathography
Mt Hope 4.1.2Forty years ago, when I decided to make dermatology my life’s work, the specialty was a far cry from what it has become. It was not then what I call and ODEAR specialty2. By this I mean a life-style profession. The ODEAR specialties are the most highly coveted by medical students today because of the perception that they allow one to have a life aside from medicine while still making a very good living.Our specialty (like most of medical practices) has metamorphosed over the past 20 years from a pedestrian activity into something that my friend, Dr. Pierre Morceau Dubois (pseudonym) calls “minimally effective cosmetic and laser dermatology.”3 We have become, or are expected by our patients to be, experts in wrinkles, rhytides, jowls, lentigines: in short, many dermatologists seem to focus, these days, on the minor skin concerns of the rich and narcissistic. In my entire training, the word “rhytide” was never uttered. You may ask, “What is the difference between a rhytide and wrinkle?” The difference, appreciated only by minimally-effective cosmetic dermatologists, is around $500.Of course, there is Medical Dermatology Society that is composed of serious, somewhat humorless folk.4 But, it doesn’t seem like they have as much fun as we did when we practiced the “old-style” dermatology. The “medical dermatologists” are the self-anointed keepers of the academic, scientific flame. What I want to talk about today, however, is the narrow path I have taken exploring the cyber-recesses of the humanities and dermatology and how this conjunction has become a hobby (some might say a “monomania”) of mine.Francis W. Peabody was a physician who appreciated both the art and the science of medicine. In an essay entitled, “The Patient and the Man” he wrote:
The proper employment of the fundamental sciences in the study of disease has become an essential for a good medical practice, but over and above this, there must be something which correlates the scientific findings with the actual problems of the individual case – the art of medicine, which carries us beyond the patient to the man.5There is a similar quote often attributed erroneously to Osler that goes: “It is often more important to treat the patient who has the disease that is to treat the disease the patient has.”

As I followed these narrow paths, trying to focus on “the patient with the disease” they took me down uncharted byways. What follows is an account of some of the avenues I have wandered through.

Sixteen years or so ago, I met Henry Foong and together we formulated an idea to start an international grand rounds of dermatology. To establish this, we hired a Williams student, Dean Loochomvorapongse, and a high school senior, Earland Johnson, to build a website. VGRD.org was launched in the fall of 2000 and it showed Henry and me the power of the web as a platform to explore our clinical and humanitarian interests.6 This led over the next few years to a number of websites and blogs that are platforms for our growing appreciation of the importance of the humanities in our daily clinical practice, and indeed in our social interactions and private lives.

VGRD’s driving concept was collaboration as described by the 16th century poet/position John Halle:

When thou arte callde at anye time,
A patient to see:
And dost perceave the cure to grate,
And ponderous for thee:

See that thou laye disdeyne aside,
And pryde of thyne own skyll:
And think no shame counsell to take,
But rather wyth good wyll.

Get one or two of experte men,
To helpe thee in that neede;
To make them partakers wyth thee
In that work to procede….

1. In 2005, some colleagues and I started a website called Cell 2 Soul.8  C2S was initially an online journal but after a short while it became clear that it was too difficult, and expensive, to deal with a webmaster; so we converted it into the C2S blog.9 This was the similar course taken with VGRD. Presently on C2S we have about 1150 entries. The philosophy behind capital C2S is to celebrate and explore the many meanings of health and “dis-ease.” It draws on the arts, social sciences and the biological sciences. Rather than being an “expert system,” it is designed to be the focus we’re professionals, patients and their families can meet on a level playing field. C2S blog provides us with an opportunity to learn from each other as well as to instruct. Chaucer stated it well when he described the student, “and gladly would he learne and gladly teche.”

While there are countless medical journals globally, even some devoted to the medically humanities, C2S is one of the first designed for both the laity as well as professional readers.

2. As physicians, it is clear to me that doctors spend a lot more time thinking about the disease the patient has than about the man, woman or child who sits or lies across from them. Books, film, poetry and other arts provide opportunities to learn about the human side of illness. This is of vital importance when dealing with “poor suffering humanity” who consults us.

As I contemplated this, I had the idea to start the next two blog:

A. A pathography is a narrative that gives voice and face to the illness experience. It puts the person with the disease in the forefront and, as such, it is an important learning opportunity for all caregivers and fellow sufferers. The Pathography blog, established in 2008, is a repository for these stories.10 Pathographies provide ways of learning to focus and perhaps vicariously understand a bit of the illness experience from the first person standpoint. Too often, in our medical literature, the voice of the patient is not heard. This blog is a place where I have indexed and described works, mostly books, that touch on diverse aspects of the illness experience.

Freud wrote: Wherever I go, a poet has been there first.

Kafka stunned us with: A book must be the axe for the frozen sea within us.

The poet Tracy K. Smith tells us: I wanted to write the kind of poetry that people read and remembered, that they lived by — the kinds of lines that I carried with me from moment to moment on a given day without even having chosen to.

Often, when I am doing a surgery, I think of Emily Dickenson’s prescient haiku-like:

“Surgeons must be very careful
When they take the knife.
Underneath their fine incisions
Lies the culprit – Life!”
7

B. Similarly, film for me, at least, provides another opportunity to learn about the illness experience. About the time that I started the Pathography blog I had the idea for MedFlix.11   MedFlix is to film what Pathography is to literature and narrative. It provides helpful instructional tools and is a resource for those who wish to learn about the depiction of maladies in creative films and documentaries. Presently, MedFlix includes films that address over 200 health and disease-related subjects from Abortion to Women in Medicine.

While meandering along these lonely cyber-pathways it struck me how our major medical journals make it well-nigh impossible to publish articles on the human side of medicine. I have tried a few times. Since I knew the editors of these journals they humored me. The articles they accepted were chopped up and abbreviated and by the time they were published they were not something I was proud to own. It reminded me of the old saying “a camel is a horse designed by a committee” (or an editorial board).

So, in 2012, with the help of two bright students, I launched an online periodical called The Online Journal of Community and Patient-Centered Dermatology (OJCPCD).10 This serves as a place for articles that are not likely to be accepted by the Archives of Dermatology, the JAAD, the British Journal of Dermatology, the International Journal of Dermatology or other “prestigious” periodicals. OJCPCD does not utilize peer-review, which is just another roadblock to prevent the publication of the personal type of articles I am talking about. Rather, we rely on post-publication peer review as defined by Richard Smith.

For a busy clinician or layperson submitting to a major medical Journal this is often a time-sink. Expand on this…

Over the past 2 1/2 years we have published a few articles a month in the OJCPCD. One of the most recent is an article entitled “The Right Stuff: Tiffany Rocks.” Written by Pierre Morceau DuBois, M.D, Ph.D (pseudonym) it describes the type of person who is successfully applies for a dermatology residency in 2015. The author focuses on what she considers a trend in a trend is skin practitioners towards focusing on minimally effective cosmetic and laser dermatology. The practitioners of this mercantile pseudoscience are legion and are legends in their own minds. I don’t think that the conventional dermatology journal would ever consider this article for publication. If you have a chance, please read it.

It’s been an entertaining and stimulating journey down the cyber-byways of the humanities and medicine/dermatology. Even today, I’m not sure where it is leading in the long run. I feel a kinship with but Matsuo Basho, the 17th century haiku poet. He was one of the first to describe “The Narrow Way.”

       The days and months are travelers of eternity, just like the years that come and go. For those who passed their lives afloat on boats or face old age leaving horses tied by the bridal, their journey is life their journey is home and many are the men of old who met there and upon the road.
How long ago I wonder did I see a drift of cloud born away upon the wind and ceaseless dreams of wondering become aroused?
The spirits of the road that into me, and I could not concentrate on anything.   So I patched up my trousers, put new chords in my straw hat and strengthened my knees with moxa. A vision of the moon was already in my mind. I sold my hut and wrote this just before moving to a cottage owned by Sempu.
14

Clouds 4.25

References:

  1. Cavafy CP, Ithaka. http://www.cavafy.com/poems/content.asp?cat=1&id=74
  1. ODEAR: Most Favored Specialties. Online Journal of Community and Patient-Centered Dermatology. http://ojcpcd.com/elpern-d-j/odear-most-favored-specialties/
  1. The Right Stuff: Tiffany Rocks. . Online Journal of Community and Patient-Centered Dermatology. http://ojcpcd.com/dubois-p-m/the-right-stuff/
  1. Medical Dermatology Society. http://www.meddermsociety.org/
    Members of the Medical Dermatology Society (MDS) represent the heart and soul of our specialty: Medical Dermatology. The MDS is made up of the thought leaders of clinical dermatology and the teachers of the next generation of practicing dermatologists. Our members include academicians, private practitioners, and resident physicians. We specialize in the care of patients with serious dermatologic diseases. Our mission is to improve the care of patients with these conditions.
  1. Peabody FW. The Patient and the Man.   (Presented by Francis W. Peabody, MD before the NewYork Academy of Medicine, November 22, 1922) http://myoslersociety.sharepoint.com/Pages/ThePatientandtheMan.aspx
  1. Virtual Grand Rounds in Dermatology. http://www.vgrd.org

also see: VGRD Blog. http://www.vgrd.blogspot.com

  1. Halle J. The Art of the Consultation. Familiar Medical Quotations. M.B. Strauss ed. P. 65
  1. Cell 2 Soul. www.cell2soul.org (presently inactive)
  1. Cell 2 Soul Blog. http://www.cell2soul.typepad.com
  1. Pathography Blog. http://www.pathography.blogspot.com
  1. MedFlix. http://www.medflix.blogspot.com
  1. Online Journal of Community and Patient-Centered Dermatology. http://www.ojcpcd.com
  1. DuBois PM: The Right Stuff. OJCPCD. http://ojcpcd.com/dubois-p-m/the-right-stuff/
  1. Basho M. The Narrow Road (or Way) (many translations)
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