PracticalDermatology

“Will the wind ever remember?

The names it has blown in the past?

And with its crutch, its old age, and its wisdom…

It whispers ‘no, this will be the last’

And the wind cries…”

– Jimi Hendrix, “The Wind Cries Mary” 1967

Cheers to Jimi Hendrix as we evoke the winds of insanity that have blown over 2020. As the dominoes fall, levees break, and our very core fabric gets tested daily, how do I even begin to summarize the apocalypse? Now that the last of the live meetings have gone virtual, and screen fatigue gives way to rage against the machines, will we finally get the break we deserve? Or do we need to start reluctantly accepting that the matrix is real?

I chose to write this on September 11 so that I could process the severity of the swirl of intensity remembering the worst day in American history during the worst year in modern history. I figure things should be looking up from here, given that in 19 years we went from banding together in patriotism to as close to civil war as many will experience.

Rewind to February and take a moment…think about the last time you were at a meeting, eating at a buffet, sitting in a stadium, not thinking twice about masks or distancing. My family and I were returning from Cabo right before they closed the borders with news of rising infections in the US and New York City shutting down, and nobody dared cough or sneeze without risking a stampede. Now seven months later, while we miss the events and fun, do we really miss the way we held them? Do we miss how sloppy things may have been?

We just took the boys to a pool that had a waterslide. They had everyone in a line six feet apart with one rider at a time allowed to climb the steps and then signaled down…nobody standing on top of each other pushing and shoving while wet, no need to wait in long lines. Overall it was smoother and cleaner. Dining in restaurants has become more efficient and less messy. Having servers wear gloves and a mask does add a layer of cleanliness, despite the eerie feelings with a masked waiter. Even getting on a plane has become streamlined. Some of the sloppiness has been eliminated with boarding rows from the back to front, wrapped up snacks and limited drinks in cans, and maximum efforts for cleanliness including the shared air. Airline experts are doing the math on the economics of cutting down some routes, eliminating bigger aircrafts from domestic travel, and adding extra time at layovers for more stringent cleaning. While there will be fewer options from some cities, it will be easier to deal with overall…and my bet is half the passengers will continue to wear masks indefinitely. Fewer perks, such as drinks and meals might irritate a frequent flyer, but doesn’t that reduce waste, improve cleanliness, and keep the rocket fuel away from an already fired-up passenger base?

So what are the lessons learned in clinic, by pharma, and by dermatologists? Nearly empty waiting rooms, the virtual lunch, the parking lot sales call, and weekend virtual conferences are the new ways of conducting business. In what ways were we sloppy pre-pandemic? What do we have to do to make sure we don’t rinse and repeat back to what used to make things inefficient or even close to getting us in trouble for doing our jobs? I know pharma is asking itself these questions…of course using only corporate buzzwords and reading off the script (they still haven’t figured out the difference between “advice” and “feedback,” despite my best efforts to ridicule them!).

Unlike my high-ranking colleague now from Florida, I personally think the jury is still out on teledermatology. The “Virtualist” tried to convince us in June that we would be creating a new genre of home-based dermatologists since CMS will pull the carrot dangled to be distant and leave us hanging with scraps. Maybe in systems with IT departments, EMR software that actually works, and a willingness to translate HIPAA to English, we might see patients who are caught in the camera eye be maintained as virtual patients, but I can testify that my patients don’t want to be diagnosed from a fisheye lens.

It is going to be an interesting ride from here. As you know how much I care about us, I can only hope that when the clouds part we can find our footing again. I hope we regain trust in the system that binds us and from the patients who still are afraid to come see us. I wish we could all find some sense of peace in the world that seems to be lost, and that our specialty can still remain strong and united in our missions. Finally, I beg those who wish to divide us to find a new shiny object to chase than their own lofty opinions. We have enough to deal with, and between scope of practice laws being passed behind our backs, pay cuts being shoved in our faces by CMS, and morale deteriorating by the minute, now is time for the smartest people in medicine to use their brains and hearts to rediscover the joy that seems lost in practicing our craft, and to make dermatology special…again.

Acknowledgments: Thanks to Mark Kaufmann MD for his wisdom and vision, Jim Del Rosso, DO and Jeff Suchniak, MD for the music, and to Dillon Patel for always being the source.