As a medical student, I was finally starting my clinical rotations, a time of great anticipation and celebration among medical students and their families. After two years of book learning, I was going to be called "doctor" and wear my short white doctor's coat. I was thrilled! As we gathered in the lecture hall, and over the hubbub of my equally excited classmates, I notice the huge screen down in front. ...

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“Alright, sir, that’s the plan, and we will take good care of you.   What questions do you have for me?” I asked after discussing the patient’s condition and hospital course.  The patient looked satisfied and nodded as if he understood the plan, and asked: “Well, one question, where are you from?”  I immediately let out an internal sigh, knowing where this conversation was going and replied, “Well sir, I was ...

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Let’s get the jokes out first. Yes, I am a dermatologist who is on the front lines of the COVID-19 pandemic at my hospital, and no, you do not want me to intubate you. I’m a little different than most dermatologists. I also trained in internal medicine, and I regularly spend time on the medicine service. While I was redeployed to the COVID-19 clinics early on in the pandemic, I’ve spent ...

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We’ve all heard the phrase, “survival of the fittest.” It suggests that in the competitive, “free market” world, it is the “best” who survives and it’s “the cream” that rises to the top.  But is that true for doctors?  Do patients get better care when competition rules the health care marketplace? A few years ago, a doctor from a large primary care group contacted me to give a talk to the ...

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I saw a "difficult" patient in the clinic this week. We've all been there, sometimes multiple times a week. The patient who is upset and won't stop telling unrelated history. The one who comes in every week with vague complaints with a negative workup. The patient who is constantly going doctor shopping and doesn't believe what you say even though they keep coming back. The one who blames you for ...

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I'm a dermatologist, so I'm not on the front lines of this pandemic. And thanks to public health measures, I may never be called to work at coronavirus drive-thru testing sites because we are flattening the curve of infections. Nevertheless, my clinic is reserved as a hospital "surge unit," so I've converted to telemedicine to keep caring for patients—it's easy to forget amidst a pandemic that other diseases persist and worsen if ...

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My dearest daughter, Life is unpredictable. In case I won't be around one day, here are things I learned from being a doctor and a mother that can guide you always. 1. New level. New devil! There will never be a time outside of death that life will stand still. Embrace change and know that as soon as you accomplish one goal, you will need new goals and challenges to continue to grow ...

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There was outrage over the sudden rise in the price of the EpiPen. But the rise in many other pharmaceutical prices gets less attention but is just as concerning. It can be easy to forget issues like this until they affect us personally. My two encounters with irrational drug price increases for dermatologic conditions are a reminder of how pervasive this problem is today. I have rosacea, a ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is evaluated for a firm, flesh-colored lesion that has been growing on the back for several months. Foul-smelling material can be expressed from the lesion. The patient is bothered by the periodic drainage. He is otherwise healthy and takes no medications. On physical examination, vital signs are ...

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It all started with John F. Kennedy’s campaign for the presidency.  After eight years with President Eisenhower’s baldness and Vice President Nixon’s receding hairline, the American public was ready for a change.  Kennedy had great hair, which he flaunted by appearing bareheaded at his inauguration.  A new political maxim was established that day; to win in American politics, it’s not what’s in your head, but what’s on your head that ...

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Some may think that being a dermatologist means taking care of the “superficial.” I beg to defer. We spend a great deal of time performing procedures and talking to patients. During our visits, patients share their truth, and open up their hearts to us in meaningful and vulnerable ways.  We hear about their relationships, their work, their fears, and their struggles. We become a part of their inner circle of ...

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Take one-half tablet three times per day with meals, increasing by half each week until reaching a maximum of three tablets three times per day. Did you get a new prescription from your doctor? If so, there is a 50 percent chance you will not adhere to label directions. Either the instructions are too complicated, the drugs are too expensive, you do not like the way the medicine makes you feel ...

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Here is some news about cancer that isn’t widely known and is hiding in plain sight: Deaths from melanoma -- a skin cancer that has lethal potential -- have declined dramatically over the past several years. And while that fact alone is surprising, so is the reason behind the drop. Let’s make something clear at the outset: too many people die from melanoma. It is not the ...

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Global climate change is reaching a critical mass. Since the advent of the industrial revolution, we have seen the global mean temperatures increase by 1°C (1.8°F), and significant steps must be taken by 2030 to mitigate an even larger global temperature increase of 1.5 to 3C as predicted by 2030. In other words, we are in dire need of change. This change is not only reliant on governmental policy change but is ...

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I didn't match dermatology the first time. It was a harrowing experience, and I had a chip on my shoulder until the day I opened my match envelope. The reality is that in the last ten years, dermatology has become the most competitive specialty in medicine. Hundreds of extremely qualified applicants are disappointed each year. Therefore, not matching is not a reflection of one's qualifications as a future ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is evaluated for a new skin rash of 10 days' duration. The rash appeared abruptly and is not tender or pruritic. The patient has poorly controlled type 2 diabetes mellitus. His current medications include metformin and glyburide. Family history is unremarkable. On physical examination, vital signs are ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated for an intermittent pruritic rash of 8 years' duration. Medical history is significant for mild persistent asthma. His only medications are an albuterol inhaler and an inhaled glucocorticoid. On physical examination, vital signs are normal. There is mild xerosis with erythematous plaques on the bilateral ...

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Quick quiz question: two people are diagnosed with melanoma -- Sarah Sunburn, an adamant sun-worshipper, and Paula Pale-All-The-Time, a fanatical sun-avoider. Who is more likely to die of the disease? The answer is pale-faced Paula. Surprised? Let me unpack this mystery and explain why sun exposure simultaneously kills people, while making the cancers they are diagnosed with appear to be less life-threatening. I will start with what you probably know already. Melanoma ...

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Long ago, and far away, I encountered a patient that changed the way I practice. I was with a medical student while examining a middle-aged woman who presented with a dramatic eruption that was probably DRESS syndrome (DRESS syndrome was not yet described). I prescribed prednisone and asked her to come in a few days later so I could assess her progress. She returned – I did not recognize her ...

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Informed consent is the cornerstone of medical ethics. And every physician must defend this sacred principle from every form of evil that would seek to dismantle, degrade and debase it. If informed consent is the sun, then privacy, confidentiality, dignity, and trust are planets that go around it. For without informed consent, the descent of health care into amorality is inevitable, and the doctor-patient relationship is doomed to ruination, oblivion, ...

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