Shared exasperation is cathartic

Fifteen years ago I got an unexpected invitation to write a column for a dermatology newspaper aimed at practicing clinicians. Because dermatology is a concrete field that lends itself to punning, I called the column “Under My Skin.”

Writing it monthly since then has given me a chance to take a humorous and sometimes cathartic look at the joys and woes of practice. It’s fun to do, and gratifying to hear from colleagues around the country who turn out to have patients and experiences like mine. Best of all, I never run out of material. For instance:

  • The man who wanted two moles removed because his children hated them and called the moles “Eugene” — both of them.
  • The automobile salesman who asked me to sign a purchase agreement with a pen stamped by a pharmaceutical firm that makes a vaccine against venereal warts.
  • The woman who brought a list of twelve skin questions she’s been saving up for years, including where she was when the problem began and what she was wearing when she noticed it.

Then of course there are administrative matters that make modern practice so interesting:

  • Drug reps pitching moisturizers of such variety that I couldn’t keep them all straight even if I wanted to (with additives like ceramides, aloe, oatmeal, and green tea).
  • Sample cabinets that now overflow with discount coupons, each with its own terms, 1-800 number or website, and geographic restrictions.
  • Electronic medical records that require dermatologists to document and report items unrelated to our practice, like smoking habits and body mass index.
  • The impending roll-out of ICD-10, which will expand our diagnostic horizons to include new categories of illness like “Toxic effect of venom of Gila monster, intentional” (T63.122) and “Crushed between canoe or kayak and other watercraft or other object due to collision” (V91.15).

Sometimes I indulge myself by waxing nostalgic in the column about the days when I had a satellite office above my garage at home. I checked patients in myself, collected $3 co-payments, and carried the paperwork back to the office.

This seems comical in light of current requirements for check-in, which require a phalanx of clerks to check insurance eligibility on-line, scan documents, and hand out reams of consent and non-disclosure forms for patients to fill out. Once the patients run that gauntlet and actually get into the exam room, taking care of their medical issues is a breeze.

Dealing with quirky people and meddlesome bureaucrats is part of clinical life. Learning that colleagues share your experiences makes getting on with things easier.

It’s nice, for instance, to have my column’s editor forward the occasional note from a dermatologist in some far-flung corner of the U.S., telling me that his or her patients behave just as mine do.

“I think your patient came down here to see me too,” wrote one from rural Georgia. “My patients don’t show up either,” wrote another from Buffalo, “and they don’t get it when we say that’s a problem.”

Shared exasperation is cathartic. Now to monetize it …

Alan Rockoff is a dermatologist.  This article originally appeared in What Works For Me, a joint project by the Massachusetts Medical Society and the Institute of Lifestyle Medicine.

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