How do we get dermatologic care to those who need it?
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, FAAD, June 1, 2022
Many potential barriers that limit access to our services — financial, geographic, and social issues — all come into play, often combining into the perfect storm. Reviewing this month’s feature article highlighting dermatologic care in our prison systems, I realized we do not often consider those who truly lack the freedom to choose our services. Prisoners cannot access our services at will and — in the absence of anyone to advocate for them — can easily be forgotten. Several of our colleagues have not, however. They share their experiences providing dermatologic care for the incarcerated with us in this interesting story. There are challenges providing care in a closed and often complicated system, but it sounds like there are also rewards, and I’m proud that we have dermatologists who are willing to serve in this capacity. I hope you find their stories as interesting as I did.
Over the years, I have truly come to appreciate the fact that “life-long learning” is not just an aspiration, but a necessity, as our growing knowledge base continues to expand. This month, we asked Assistant Managing Editor Allison Evans to tackle the changing world of anticoagulation. Yes, I realize that some of you may still experience PTSD from having had to memorize the dreaded coagulation cascade in medical school, and you would likely prefer never again to have to check another INR. Fortunately, on that front, the direct oral anticoagulants (DOACs), including dabigatran, rivaroxaban, and apixaban have arrived. These targeted anticoagulants impact the coagulation pathway differently than warfarin and have the distinct advantage of a short-half life, with quicker onset/reversal of action. For good or bad, we cannot routinely monitor their effect; for patients, this means no routine bloodwork, but we cannot assess the degree to which they are anticoagulated by checking INRs. Unlike warfarin, DOACs lack a specific antidote. So how does this impact us as dermatologists? Many of our patients are on these medications, and our surgical colleagues certainly consider this in their management. Anticoagulants may have a role in the treatment of dermatologic conditions in which hypercoagulability may play a role, such as livedoid vasculopathy. As such, these are drugs we should all be familiar with, and we hope this review helps.
If you have read any of my previous columns, you have probably realized I will rarely miss a chance to brag about the wonderful leadership opportunities the AAD offers. I have occasionally been asked, “How do you become a leader?” While some of our colleagues seem to be born leaders, many of us have benefitted from leadership training. Yes, leadership skills can be taught — communication techniques, conflict negotiation, and organizational skills, to name a few. Foresight from some of our prior AAD leaders recognized the importance of developing our future leaders, and for the past 20 years, the AAD has actively invested in the Leadership Institute. Over 1,200 of our colleagues have engaged with the multifaceted leadership training program, many of whom have served as AAD leaders. Others lead in their jobs, their communities, and other derm societies. If you aspire to leadership, or just want to improve specific leadership skills, consider looking into the many opportunities offered through this amazing program.
I cannot close without mentioning the special treat we have for you this month! Everyone’s favorite coding expert, Dr. Alex Miller, makes a guest reappearance, sharing his valuable advice on the coding front. Welcome back, Alex! And happy summer! I hope it is finally warm and sunny (but not too warm and sunny) wherever you are. Go, sunscreen!
