An Indian doctor with vitiligo shares his story [PODCAST]

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“Growing up, my family sheltered and protected me with everything related to vitiligo. People never really asked me what happened to my skin. And, if I did get questions, I honestly did not know how to answer them, so I would say ‘oh, they’re just sunburn scars’ or some version of that story, and moved on. Thinking back, I probably was too supported and busy to really have an opportunity to be bothered by it. That, in itself, was a blessing. I pursued many years of schooling and training to ultimately become a practicing physician.

Now that I’ve been in medicine for many years, I primarily value and cherish the connection with my patients, as I sincerely believe medicine is fundamentally about the human experience. But, when I hear statements like ‘you don’t look Indian’ from patients, I am constantly reminded each time that I have vitiligo. Reflecting on how best to answer this question, I ask myself if I should react and explain the skin condition, or just let it go. The truth is that the majority of the time, I do ‘let it go’ when it comes to discussing my skin condition with patients. I simply don’t want to explain to patients that I have vitiligo.”

Dhaval Desai is a hospitalist.

He shares his story and discusses his KevinMD article, “The story of an Indian doctor with vitiligo.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Dhaval Desai. He’s a hospitalist, and he wrote the KevinMD article “The story of an Indian doctor with vitiligo.” Dhaval, welcome to the show.

Dhaval Desai: Thanks for having me, Kevin. It’s really an honor to be here with you.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Dhaval Desai: Sure, so thanks. So I’m a practicing hospitalist here in Atlanta, Georgia. I’m actually from Georgia originally. I went abroad for my medical school. I went to American University of the Caribbean in St. Martin for two years, and I came back to the States, did some clinicals in New York City, and did my training in med-peds at Wright State in Dayton, Ohio. And I found that hospital medicine, being on the inpatient side, was my passion. And I made my way back home and joined Emory Healthcare back in 2012. And in 2015, I became the site director for hospital medicine here at Emory St. Joseph’s Hospital.

Kevin Pho: And we’re speaking in the middle of October. How is the pandemic affecting your practice and your hospitals?

Dhaval Desai: Thanks. Yes, the pandemic’s been quite a journey. We’ve gone through two surges so far. Our second surge, in July to August, was the most challenging one that we had. I think we had at one point between 80 and 100 patients in the hospital with COVID. And it’s been a journey. We’ve come down from that. We’re starting to creep up. The adrenaline is starting to wane a little bit, so we’re trying to get some energy for the next wave that comes our way, but we’ve learned a lot. We rallied our troops, you know, so to speak, and we’re just taking it day by day.

Kevin Pho: So let’s get into your KevinMD article, “The story of an Indian doctor with vitiligo.” Now, for those who haven’t read your story yet, can you walk my audience through it and maybe share why now is the time to share it?

Dhaval Desai: Sure, sure. So it’s one thing I don’t always like to talk about, but I decided the time was right to talk about it. So vitiligo, for those who aren’t familiar, is an autoimmune skin condition that involves destruction of your melanocytes and steadily losing pigmentation in your body. And it can happen in varying phases. So it can start with very patchy, small areas of your body and then spread. Some people have it very stagnant, where they have small patches throughout their life and it doesn’t spread. And other people have progression of their disease. And I went through a few different treatment modalities growing up and ultimately had steady depigmentation, and that’s where I’m at right now.

You know, being Indian, typically most Indian people’s skin color is brown. Over the years, I’ve gone from a moderate shade of brown skin color to completely white. So it comes up quite a bit for me in conversation, generally speaking, and also from a patient care standpoint, in that people see my name and assume it’s Indian and look at me and say, “Are you mixed, or do you have a little bit of American and Indian in you? Where are you from?” And then that kind of starts the conversation. And, you know, it puts you in a vulnerable spot. It puts me in a vulnerable spot. Do I want to bring up, “Well, I actually have vitiligo, and that’s why I appear this way,” or do we just let it go? And honestly, most of the time historically, I’ve let it go.

And this year, as everybody’s putting it, and I fully agree, we’ve had two pandemics. One is obviously COVID-19, and the other is the pandemic of racism, and how that’s really becoming such a pressing issue in our country, people being judged based on their skin color, and the health inequities associated with that. And I thought it was a good time for me to share my story with vitiligo.

I, first and foremost, have not gone through what somebody who’s African American may have gone through from a racism standpoint, being judged on their skin color and having any repercussions from that. But I have gone through instances in health care when I’m faced with people looking at me, at my skin color, and asking me, “But you don’t look Indian.” And it kind of puts you in a position. What do you say to that? And it’s a distraction. It’s a distraction many times for me when I’m delivering patient care.

Kevin Pho: When patients ask you that question, what do you say, and how do you respond?

Dhaval Desai: Yeah, so typically, Kevin, I just don’t say anything. I just kind of either ignore the question or brush it off, or I say, “I get that a lot,” and I change the subject rapidly. The reason I do that is I never want something about me to be a focus for the patient and be a distraction from the care I’m providing. But internally for me, it’s always been a distraction, and I have to train myself to not react and not kind of ruin that patient encounter, so to speak, and still let me do my job. It still takes me, when I leave that room, after that, kind of 30, 40 seconds to brush it off, regroup myself, and then move on to the next patient. But that does come up.

And then, you know, I deeply analyze what’s going on. Are they assuming I’m Indian based on my name? And then, are they assuming that if I’m Indian, I’m going to provide a certain type of care, be a certain type of doctor? All these questions come up. So it’s one that I don’t like to get into with patients. I don’t think I’ve had, maybe, one or two times with a patient where I’ve explained to them what’s going on, but other than that, I don’t get into it with them.

Kevin Pho: And has your story of vitiligo affected your pathway and journey as a physician?

Dhaval Desai: If anything, it’s made me more empathetic. It’s made me more able to relate to the human experience and the patient experience. So, Kevin, one of my passions is the patient experience and optimizing that for patients, especially in the hospital, communicating, navigating, kind of handholding a patient, so to speak, because I feel we lose a lot of that in this day and age. So this has kind of given me a different perspective on that human experience side of things.

I feel when I was in medical school, sometimes I was trained that you have to let go and just kind of be that for the patient and not think of any of your own things going on, but this is just a reminder that you’re a human first and you’re a doctor second. So having that experience makes me a little bit more relatable. I’m able to relate and empathize more with patients and get on a more connectable level with them. So it’s given me that perspective.

Kevin Pho: So we talked about your relationship with patients, but what about colleagues? Has anything changed with your relationship with your colleagues and administration?

Dhaval Desai: So in terms of vitiligo and colleagues, now I tell them when it comes up. I openly tell them that I have vitiligo. I did not do that at the start of my trajectory with this, when I was in med school. I was still probably two shades, and this is an anecdote, but I think it’s a powerful anecdote.

When I was a third-year medical student, I was on a family medicine rotation, and I actually had an attending come up to me, look at my neck, and point out, “Oh, you have white patches there,” and bring another physician in the hallway, both of them looking at me and examining me and saying, “I think that could be vitiligo.” And I was completely perplexed. And think how inappropriate that was on so many levels. And, you know, as a med student, it was very hierarchical at that time for me. So I didn’t say anything, and I moved on, but that was very demoralizing during that time.

Kevin Pho: We’re talking to Dhaval Desai. He is a hospitalist, and he wrote the KevinMD article “The story of an Indian doctor with vitiligo.” Now, for other clinicians who have similar situations like you, do you have any advice or tips that you could share with them?

Dhaval Desai: Yeah, so my advice is that whatever you have, if you have some type of disability or something that’s physically obvious, that’s deviating from what we call normal, no matter what you do, it’s still going to be recognized by the patient. We have to train ourselves to not get distracted by that, to anticipate that it’s coming, and to just keep moving on and continuing to deliver the care. I’ve found there’s no way to hide these things at the end of the day, and we have to still continue to do our job.

If it comes up to a point where you’re comfortable and have a relationship with a patient, maybe a long-standing PCP relationship, and it comes up, I think it’s perfectly OK at that point to talk about what’s going on, whether it’s a physical disability or something going on, and having that rapport. Maybe on your first time, that’s really hard to do when you don’t have that rapport. But when you have that relationship, I think it’s perfectly OK. And in my instances, the few times that I’ve done that, it’s added much more rapport and collegiality between myself and the patient.

Kevin Pho: You talked about that story when you were demoralized as a medical student. And I don’t know how many years ago that was, but have attitudes changed over the years? Have you noticed any change?

Dhaval Desai: Either they’ve changed, or I’ve become more accustomed to it, or matured with it. It’s hard for me to say. I do think that the events of this year, as unfortunate as they are, you know, from the death of George Floyd and all of the movements that we’re having for anti-racism, are so key. So I do think we’re at a very pivotal point right now, where the culture is being catalyzed. But for me, I think it’s a matter of being more comfortable talking about it, and that’s come over time with experience and maturity, I think, for me.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Dhaval Desai: Yeah, so no matter what, focus on the human and patient experience in medicine. Avoid being that robotic provider or physician where you’re just asking questions, doing your job, and getting out of the room. Establishing that human and patient connection, the human and personal connection with that patient, is something that we need to continue to value. And my experience of vitiligo is just part of my passion to do that, but that is one area that we in medicine, in this day and age, cannot lose. So that’s my main message I’d like to send.

Kevin Pho: Dhaval, thank you so much for sharing your story and taking the time, and thanks again for being on the show.

Dhaval Desai: Thanks for the platform, Kevin.

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