PracticalDermatology

It’s been a lot of fun these past few years hasn’t it? A good holiday season and hopes for 2023 are upon us, and the time for good cheer in the office and at home is here…and yet, sadly, many of us are still in a post-pandemic haze trying to regain our footing. Seems we’re all waiting in line, but does it seem like we’re wasting our time? I can definitely feel it coming at me, and did I miss again? Sorry, I had to throw that in, but more and more it seems like we, as dermatologists, are on the outside looking in.

Since we’re on music, every fan of the Talking Heads remembers “Girlfriend is Better” with one of the best lines and album title “Stop Making Sense,” although my favorite is still “Once in a Lifetime” with the famous lines “Same as it ever was” and “And you may say to yourself, my God, what have I done!”

That is my concern as we continue to see the demise of the dermatology dictionary. “Dermspeak,” the code that bonded us and made us unique, is constantly under siege by corporate dilution and the magic of influencers who reach more patients than physicians ever will…oh sorry, I meant providers…not.

During my training days, grand rounds consisted of morphology descriptions that had to be precise and our pathology conferences required the exact language necessary to describe and conquer…or risk having your butt handed to you in shame. That fear of humiliation—usually mine—taught us to rehearse and be on top of meanings and descriptive terms unique to the skin and to histological specimens, because that was the way we communicated about patients in notes and reports and how, in a convoluted way, we stuck together in our specialty. Little did we know that cardiology with EKG readings and radiologists with imaging reports relied on this precision in description to keep the message straight, but also to keep theirs as theirs.

Now enter an era years later, not just where teaching by shame is extinct, but where the dilution of the dermatologist’s vocabulary is going the way of the passenger pigeon. “Text” is a verb, “invite” has replaced “invitation,” “pivot” no longer just refers to basketball, and abbreviations, emojis, and sentences that don’t start in pronouns have taken over proper communication. But even better is the new creative language of the self-proclaimed experts of health care, especially the dermatologists who aren’t. Terms like “melanized” to describe hyperpigmentation, “purging of acne” to describe getting worse before getting better, and countless other terms that would make Ackerman, Fitzpatrick, and Kligman turn over in their graves have taken over the glossary…and for the most part, the playbook. “And the knowledge that we fear, is a weapon to be held against us.”

Take a minute to read the review letter, “Instagram influencer definitions and the need for dermatologist engagement on social media,” published in JAAD in December 2020. It points out some significant changes to the education of patients, and the dilution of how our diseases and therapeutic effects are described (nice job Dr. Lipoff and crew). The original article, “Dermatology without dermatologists? Analyzing Instagram influencers with dermatology-related hashtags,” should start a chain reaction of sweat and concern for our future. In this version of our specialty, as many have foreseen, dermatologists might find themselves constantly playing defense with our patients who trust the influencers more than us, and being boxed out as too expensive and too difficult. Who can argue that physicians are the last to organize and the first to turn on each other? Of course every doctor can…duh!

In the end most experts in marketing dermatology practices, including my colleague Naren Arulrajah, a regular author in this journal, advocates the services of influencers to reach patients on social media outlets. His article is comprehensive and useful for all of us, but in the end the patient messaging is our responsibility for accuracy and safety.

I am sure this trend is only going to roll downhill, where only a few practice models might escape the influence of influence. Hopefully this can be contained before patient safety becomes an issue. Paging Dr. Sandra Lee, come and save us! Hopefully, too, it is something we can just watch, and isn’t another nail in the coffin of medicine as we once knew it. I still think we are blessed to practice dermatology and to have made it this far in our careers, and to have the trust of patients everywhere.

I guess we have yet to see what comes next for the guardians of the skin. There is a music reference here somewhere, but I am drawn a line from “Mystery Man” from The Outfield many years ago, with the dark cry, “In the middle of it all, he can’t waste no time…in the middle of it all, he just says Goodbye…”

Further Reading:

Ranpariya, V, Chu B, Fathy R, Lipoff, J, “Dermatology without dermatologists? Analyzing Instagram influencers with dermatology-related hashtags,” J Am Acad Dermatol, Vol 83, Issue 6, 1840 - 1842

Peck GM, Bhatia N, Korman AM.” Increased use of nonspecific language to describe physicians in 2 major dermatologic journals,” J Am Acad Dermatol. Published online October 27, 2021.

Sitton, B, Korman, AM, “Dermatologists, not “providers,” J Am Acad Dermatol. Published online August 8, 2022