PracticalDermatology

At the Battle of Mobile Bay…warned of mines (called torpedoes) in the water ahead…Farragut said, “Damn the torpedoes! Captain Drayton, go ahead! Jouett, full speed!”

– David Farragut, an officer in the Union navy during the Civil War

“Tell Mr. Dennit that Ricky Bobby is my best friend…and it’s Shake and Bake time…Damn the Torpedoes!”

–Cal Naughton in Talladega Nights

Whether you credit the Civil War hero, the Tom Petty album, or the quote by John C. Reilly coming to rescue his beloved Ricky Bobby, the phrase “damn the torpedoes” has been timeless when it comes to staring peril in the eye and plowing ahead, throwing risks out the window. Maybe in dermatology the applications can vary, whether it is about moving forward with isotretinoin, going to yet another meeting instead of staying home, or pushing back the hard stop time before bed…but everyone has been there one way or another. Oh, and my apologies, it’s probably the first time in my 15 years of editorials that obscenities made the title…but why not mix it up?

Moving full speed ahead in our lives, our careers, and even our patient care, seems a lot easier now with technology at our fingertips. The ability to manage outcomes for systemic therapy is now readily accessible, as is following our child’s progress in school, and when to speed on the highway almost always has permission from the apps in our cars. Basically, unlike in the 1800s, full speed ahead takes on a new meaning when risks are mitigated by the ability to see into the future. Of course, the high achievers who are members of the DermFrat are hardly afraid of hitting the gas and staring their obstacles down, and the accolades often follow suit.

The other side of that equation is the risk of losing filters, and consequently, perspective, when throwing caution to the wind becomes the new norm, even creating a sense of being bulletproof when there is disregard for any guardrails. Whether it is in our behavior professionally or personally, in our language, or in our actions, moving full speed ahead can backfire quickly. The vortex of balancing work in our lives often collides full speed with our personal sanity, especially when the rewards to the wallet or ego can cloud the need to pump the brakes…and smell the roses too. Even more importantly are the friends who are bold enough to tell you what you need to hear at the most crucial times, rather than watering down the truth to spare your feelings.

Unfortunately, in this new age, the term “torpedo” has become an unpleasant verb that represents many similarities to the Civil War marine ambush. The ease of how a job application, an online review, or any attempt at describing character can be “torpedoed” is becoming an issue in society, definitely taking us full speed backwards. To me, there is no better version of this kind of torpedo than the online review, where it is so easy to take aim and fire from behind the screen. We just had a one-star review from a patient who was given a gift card for not qualifying for a trial to compensate for time and gas, and within an hour we were getting torpedoed for the card not having enough to the subject’s satisfaction. ‘No good deed goes unpunished’ has evolved into ‘any good deed can still get torpedoed.’

The risk of getting torpedoed is on the rise in medicine and the corporate world, coincidentally, as we see more anonymous snipers and frenemies at every turn (now that’s another editorial in the making). Professional and personal jealousy, ambition without checks and balances, perceived competition, or obstacle to promotion are only a few sources of the urge to fire torpedoes. One can imagine how many complaints, negative reviews, and attempts to dismantle another’s reputation or standing come from those with some axe to grind or hidden agenda, yet other torpedoes are fired simply to watch the competition fall by the wayside. Whether it be a suggestion at a committee or board meeting, a solicitation to join a society, or even the simplest discussion of where to have dinner, the common action seems to emphasize the protection of the anonymous torpedo launcher, which is tantamount to free shots by the sniper, while the target of the torpedo is usually guilty by default and rarely gets a chance to save face or play any defense.

In the end, the torpedoes fired at our fellow dermatologists allow our real enemies and frenemies to erode our fabric. The energy used to divide us should be spent on defending us from those with bigger torpedoes from bureaucrats and non-dermatologists, and the theme of unity needs a chance to prosper. We have all seen the aftermath of division no matter what the issue, and as a specialty that is constantly under the microscope and on everyone’s radar, we can’t risk the collateral damage of torpedoes that are fired at our own when we need to be full speed ahead as advocates for our patients, our scope of practice, and our reimbursements. When infighting and social media torpedoes take priority over working together, then we are definitely moving full speed backwards.

So what are the countermeasures to neutralize the torpedo? Do we continue to keep our defenses up when we don’t know where and when they will be launched, or by who? Or do we continue our pace while doing our best work despite the risks…and damn the torpedoes? I look at some of the targets of previous torpedo assaults, and all of them are not only still standing, but they are stronger and more well-prepared for the next time…and it’s full speed ahead. Let’s all find our inner fortitude to keep moving forward, and leave the torpedoes in the rearview mirror.

—Neal Bhatia, MD, Chief Medical Editor