PracticalDermatology

All the same we take our chances
Laughed at by time
Tricked by circumstances
Plus ca change
Plus c’est la meme chose
The more that things change
The more they stay the same

—Rush, Circumstances

Strange to be talking about changes this time of year as usually this is a New Year’s resolution conversation topic or a theme for some major upheaval. But, alas, we find ourselves in summer, starting a new academic year as of July, already halfway through what seems to be a peaceful year, and as usual watching the clock … instead of working the clock, remember? The real clock-watchers are cut from a different cloth than those who think they can work the clock, but in the end the same outcomes often prevail…routine, habits, innate drive, and fear of one’s shadows often prevent the implementation of substantive change.

By Oxford’s definition, “change” as a verb is to alter, to modify, or to replace something with something else of the same kind that is newer or better; however, as a noun “change” is the act or instance of making or becoming different.

Changes to the surface can often bring a sense of solace and purpose, even a change of perception. For example, this journal will have a facelift in July with a new cover design. Additional changes are forthcoming, including a new color-scheme, redesigned layout, and an increased use of images. We will have a new managing editor and new staff members. We also welcome Collin Blattner, DO, and Christopher Bunick, MD, PhD, our two newest editorial board members, who represent the first in what will be a number of board-member additions. And significantly, there will be an increase in content intensity such that the usual articles and narrative will not be so usual.

Patients change doctors, teams change coaches, and drivers change cars. These changes are usually meant to be upgrades and to refocus the goals. Personal changes can be minor and may take little effort to achieve the desired results. But real change, especially those that involve that person in the mirror, are usually the most difficult because of the layers of denial, of bargaining, and of the eventual acceptance of which changes are essential. The skin cancer patient who still tans, the acne patient who picks, the rosacea patient who loves ghost peppers, and the psoriasis patient who is overweight—these behaviors might be easy targets for dermatologists to suggest a few changes instead of just suggesting prescriptions. It gets a little more complicated when the dermatologists as the messengers aren’t practicing what they are preaching and need their own intervention. Prioritizing sleep, temper control, watching the ins and outs, and taking time to smell the roses are often messages from a webinar or burnout course, but the failure to implement even one of the changes that we know we should, or when our loved ones insist we should, doesn’t make us much better than our patients that we scold … if anything, it makes us hypocrites.

The little angels and devils that we know sit on our shoulders—the ones who create a balance between willpower and discipline vs indulgence and selfishness—are voices we should often take a pause and listen to. Physician talk about patients’ use of more sunblock when outside, getting more exercise, adding an hour of sleep, and finding a hobby often falls on deaf ears when the machinery of self-awareness and consequence is lost in our patients, and yet those same changes in physician’s behaviors should be held at a higher standard.

Simply rewind to a few editorials ago where “letting adults be adults” tells a great story: one person can ruin it for the whole system by getting overserved and the entire institution of “promotional speaking for pharma” suffers. Such is the case for any scenario in which a sweeping change can be an overreaction, while the impetus for the change is often underreacted to.

As we start the second half of the year, with a new cover for this periodical, let’s think about what other changes might require new makeovers and which need heartfelt interventions. More importantly, when we think of our patients’ welfare we should all start with the mirror and end with our vision of desired outcomes. Some changes might benefit from a few cosmetic upgrades, but if the real ones are necessary then they should come with substance … just not substances, so to speak..