From the editor
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, April 1, 2019
A lot has changed in medicine over the past 20 years. We have new diseases, new understanding of old diseases, and innumerable new medications with which to practice our craft. More importantly, the very environment in which we practice has been fundamentally, and permanently, altered. When I trained, physicians had privileged access to medical information, and we owned the currency of health literacy. We had the knowledge, and it was our job to educate our patients about health and disease. What they needed to know they got from us, supplemented by tidbits from their friends and family members, and an occasional article from Reader’s Digest (who could forget “I am Joe’s Liver”?). As the primary source of medical education, we were able to steer the conversation and feel confident that we were providing our patients with relevant and appropriate medical advice. This did not, of course, guarantee that our patients followed our advice, but we had at least some reassurance that we had done our best to inform our patients.
Things are different today. The ready availability of an almost infinite amount of information — for which there is little quality control — guarantees that many of our patients arrive for their visit armed with information gleaned from Dr. Google. With this, they bring a multitude of well-informed questions, preconceived ideas, and often a presumed diagnosis in hand.
We could argue ad infinitum as to whether this is good or bad, but it does mean that we need to be prepared for these interactions and develop strategies for how to work with the patient who presents with what we might consider “alternative” beliefs. My state of residence allows naturopaths to serve as primary care providers (and, yes, they can and do prescribe medications, including narcotics), so I regularly address and reconcile differences in our medical care recommendations. This requires time, patience, and tact if I am not going to seem dismissive and insulting of the care provided by their trusted PCP. At times, it can be very difficult; however, it is critically important, as discussed in this month’s feature article, to talk with our patients about the care they are receiving to fully understand the whole picture. I try to focus on the positive things that Western medicine can offer them, while trying to steer them away from any potentially unsafe alternative practices.
In some cases, I believe we can work together with alternative care providers to enhance the care of our patients. I recall one of my favorite patients with dermatomyositis, who openly sought care simultaneously from her Eastern medicine doctor. I managed her immunosuppressive regimen, while her other doctor, whose assessment included the concept that she had “too much heat in her body,” prescribed “cooling diets,” consisting of lean meats, few carbohydrates, and lots of green vegetables. I certainly could not argue with that! Do I always agree with the alternative approach? Of course not, and l will confess to a certain amount of righteous glee when I inform patients that their essential oils are actually the cause of, and not the cure for, their itchy rash. But I do try to ask, and I try even harder to listen.
I will close with a tip that may make your life easier. Read Acta Eruditorum this month. In his usual calm and understated manner, my good friend Dirk Elston, MD, makes treating delusions of parasitosis sound almost easy. These few paragraphs will hopefully give you the confidence to treat this debilitating and challenging condition. And maybe someday, we will find an essential oil that also helps!
