Treat the patient who has the disease, not just the disease.
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, FAAD, February 1, 2024
This month’s feature article about managing skin cancers in the elderly resonated with me, as it addresses a concern that I have had for some time about the way we practice medicine in this day and age. Perhaps because our attempts to better understand disease pathogenesis have been so successful, our goal as physicians has shifted from “healing patients” to “curing disease.” Think back to your medical school education; if it was like mine, you were taught how the body works, how it breaks down, and how to fix it. Disease was the focus. Less time was spent understanding how these diseases impacted the patient, and almost none considering how the patient might interact with the disease. Nowhere is this more evident than it is in the care of our elderly patients.
I recall as a young dermatologist seeing an elderly patient whom one of my senior colleagues had seen not long prior. I somewhat righteously identified several basal cell carcinomas that I assumed my colleague had missed and wondered how he had missed them. It took me several decades of practice to acknowledge — and even more so, to understand — that my colleague saw them but elected not to address them. They were almost certainly not going to impact our patient’s overall wellbeing, and I’m pretty sure now that I did not do the patient service by treating them. I was strong in my efforts to stamp out disease, but completely forgot to consider the impact of the disease and the potential treatment on the actual person affected. It has taken me years to truly appreciate that healing encompasses far more than simply “curing” disease. Sometimes, the best choice for a given patient may be to not treat. Kindness, compassion, conversation, and even physical touch can all be effective healing balms. Some cancers in the elderly certainly warrant treatment, but there is more than the diagnosis to consider in deciding how to do so.
If you are lucky enough to have a pediatric dermatologist with whom you collaborate, you already know that they are worth their weight in gold. Most, in my experience, are fierce advocates for their patients. This dedication to ensuring that children get the care they need for their skin conditions has resulted in many valuable resources that we review for you this month. If you provide dermatologic care for children, I believe you will appreciate our informative toolbox with information about many great organizations and sites that might be of benefit.
If you are vexed by drug shortages (and who isn’t?), you may appreciate our “Answers in Practice” this month. Our practice management team has done a fabulous job of putting together all the many resources the Academy has created to make this task somewhat easier. This lidocaine shortage, compounding medications, step therapy, prior authorizations. They’re all there and the Academy has you covered!
Finally, this month, we wrap up our discussion of cybersecurity by addressing best practices for keeping your practice safe. We may not be able to completely avoid cybersecurity problems, but there are steps you can take to mitigate risks. Moreover, there are important steps you can take to minimize the trouble you might encounter should you have a breach: do a security risk assessment and have a risk mitigation plan. It is that proverbial “ounce of protection” that might save you misery in the future. Consider it a belated new year’s resolution!
