So much has changed
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, FAAD, August 1, 2022
Last month, we touched upon the impact of innovation in dermatology. This month, I am struck by how all three of our feature articles, and even some of our columns, reflect how much the practice of medicine has changed over the past few decades. Medical decisions used to be made largely between the doctor and patient, with us providing most of the knowledge upon which decisions were based. Doctor-patient relationships were founded on trust and presumed to act in the best interests of our patients. Did we, as physicians, always succeed? Obviously not, and as someone who has long advocated for what is now coined “shared decision making,” I would never wish for a return to the days of the paternalistic doctor who unilaterally made decisions for the patient. However, today it seems that “Dr. Google” has more influence on some of our patients that we do. Is this all the result of easier access to information, or did we somehow lose our patients’ trust? Several of our colleagues share their experiences with self-practiced medicine in our feature article this month, “Paging Dr. Google,” offering us their thoughts on hopefully effective ways to engage with patients in a healthy, balanced relationship. I found their insights to be helpful and hope you will too.
Who delivers dermatologic care has also evolved over the years, and scope of practice is a topic that elicits strong feelings from many of us. The AADA has long supported the physician-led team as the safest and most appropriate context for nonphysician practitioners to work in. Scope of practice issues are one of the organization’s top advocacy priorities and this month in our feature “Team captains,” we share some of our successes. Truth-in-advertising is a related advocacy priority and I think you will enjoy reading about the amazing success of one of our colleagues, Dr. Carrie Davis, who worked tirelessly with the AADA to pass legislation in her home state prohibiting the use “dermatologist” by nonphysicians. She makes it sound simple (trust me, I am sure it was not), but I hope that reading about her efforts in this month’s Advocacy News Roundup might inspire more of us to join in the advocacy fight!
Even when physicians are leading care, we are not always able to access the medical treatments we recommend. Pharmacy benefits managers came essentially out of nowhere to now control the bulk of pharmaceutical sales in the country. They control which drugs your patients have access to, and how much they will pay, using various tactics to ensure high profits. I doubt they taught you about PBMs in medical school, but for certain they are affecting your practice, as well as your patients’ access to the medications they need. We introduce the concept of PBMs in this issue of DermWorld; next month, we will explore more about the impact PBMs have on drug prices and access.
So, the profession I started with years ago looks very different than the one I will end with. Some changes are definitely for the better; others, well let’s just say the jury is still out. I try to be optimistic and hope that with change, comes opportunity. I cannot say that I can personally imagine an upside to having pharmacy benefits managers, but the need to control costs is real. It is just very difficult living in a time when so many important decisions that used to be left between a physician and patient are now in the hands of others.
