PracticalDermatology

Although some of the lyrics in the famous Beatles song are a little erratic, the poignant message driven from John Lennon’s voice is timeless. As we heard in 2017 from countless of our colleagues’ voices, including Dr. Mark Kaufmann’s compelling editorial to close the year, it is essential now more than ever for our specialty to show a united front. Lots of strides have been made for improving our reimbursements, for our image in the public eye, and for doing what we can for our patients. However, we cannot risk appearing fragmented when the sharks in the RUC tank are ready to eat us for lunch, and when the media ambushes us, publishing the exceptions as the norms. As we talked about before, we don’t take a knee, we get up for the challenges because our patients need us to.

The inspiration for this topic came from the false alarm of the missile launch in Hawaii in January. We were at the Winter Clinical Conference and had just finished the first morning session and housekeeping announcements when everyone’s phones went off with the alerts…but unlike the anticipated amber alert it was “BALLISTIC MISSILE THREAT INBOUND TO HAWAII. SEEK IMMEDIATE SHELTER. THIS IS NOT A DRILL.” (That’s Dr. Kaufmann’s phone screen above.) As we looked at our phones, we were in disbelief at first, then hit with the horrific reality that we were all going to possibly die in the next few minutes.

There was a menagerie of responses: some stood in denial thinking it was a false alarm or test, most grabbed their phones and tried to either look up the story or call their loved ones, and those who were there with family ran to the door to find them so they could be together if this was truly the moment of truth. As one can imagine, it was hard to process, and what struck me as I tried to process all of it were the looks of horror on our colleagues’ faces and, for some, the acceptance that we all might be vaporized in that ballroom. But at the same time there were many voices of calm urging us to not panic and run, and others giving hugs and trying to bring some sanity to those who were upset as the news of the false alarm started to come through. The meeting was obviously not the same from that moment…but as colleagues came together to weather that event, it actually led to some new friendships being made as well as an appreciation for what it was we were doing there away from loved ones, including for me, a three-year-old son and pregnant bride back on the mainland who weren’t too happy that I was alone there.

The relevance of the moment was that the crisis brought the dermatologists together, but the observation should be that we are already strong as a group and need to build on that. Maybe a life-threatening nuclear event is a bit of an extreme stimulus for it, but there might be other events that are bound to attack the specialty that could be just as explosive. Another negative article, another flawed CMS policy, another merger attempt between pharmacies, insurance companies, and venture capital groups…all of these could be destructive to us! We don’t need a mushroom cloud to teach us that we can learn to minimize anything that could splinter the group. Rather than panic and run, rather than accept our fate, and rather than freeze, we all need to focus less on making philosophy into policy and come together to make the best decisions and outcomes for us. We all come from different walks of life, different types of practices, and even different outlooks on what we accept. But now more than ever we need to celebrate dermatology, and dermatologists, and not let what we cherish implode.

Come Together…Right Now…Over Us.

—Neal Bhatia, MD, Chief Medical Editor