PracticalDermatology

Is it true? Has the expert of experts Dr. Oz fallen from his throne as the source of all medical wisdom? What will our dermatology patients do now? After all, heaven forbid that they don’t get all of their “knowledge” from Dr. Oz, Dr. Google, or any other self-professed medical scholar with a talk show and much more experience than a board-certified dermatologist. And who, of course, don’t have to deal with dermatology MOC!

Believe me, my own mother, whose children are an oncologist and dermatologist, is more likely to take advice from the Internet or a talk show host than from her own children. One night she sat up until midnight looking up the side effects of her blood pressure medications and found that they can induce anxiety. My response was, “So does staying up until midnight searching for side effects.” She yelled at me and went to bed.

The great and powerful Oz was the subject of a poll conducted by SERMO. Of the 1,300 doctors who took the poll, 735 doctors wanted him to resign from his faculty position at Columbia. Fifty doctors (four percent) said Dr. Oz should have his medical license revoked. And 280 doctors (22 percent) said he should resign from his position and have his license taken away. Eighteen percent said Dr. Oz should do nothing, because they respect him as a physician (he is a cardiothoracic surgeon). For the record, Dr. Oz comes from high institutions of training: According to Wikipedia, in 1982 he received his undergraduate degree at Harvard University and got his MD and MBA degrees at the University of Pennsylvania’s Perelman School of Medicine and Wharton, respectively. Plus, he has been a professor in the Department of Surgery at Columbia University since 2001. His research interests include heart replacement surgery, minimally invasive cardiac surgery, and healthcare policy.

Dermatology, however, is not in his wheelhouse, which brings us to the crux of the problem: How do we get patients to understand that the knowledge base for skin diseases, whether they are medical, surgical, or aesthetic in nature, start and end with board certified and quality trained dermatologists? What do we have to do to intercept the flow of information—often incorrect or at least incomplete—from those selling snake oil to our patients and causing them to print out their entrenched bad ideas before we see them?

And even more interesting: In this era of full disclosure, Sunshine Act, and the endless scrutiny by patients of potential unfounded kickbacks for writing drugs and doing procedures, many of these “celebrirty” so-called dermatology experts get a pass for their endorsements and for supporting products as well as unsupported treatments that, as we have all seen in the office, can potentially do more harm than good. (I swear, if I see one more acne patient who uses coconut oil and then comes in with a flare I am going to scream!) Why does that double standard exist and how do we combat it when we are trying to do the right thing and keep those potential conflicts separate?

There is some good news on this front. A survey published by WebMD in 2010 made a direct correlation to the educational level of patients and the trust level placed in doctors.

From the website, the findings were correlated as follows as to how education affects confidence:

• Among people who’ve done post-graduate work, 71 percent are confident in the accuracy of their doctor’s advice, with the remainder, 29 percent, feeling it’s necessary to do some research or additional checking.
• 69 percent of college grads are confident their doctors are right, and 72 percent of people with some college feel the same way.
• 70 percent of people with a high school education or less are confident in their doctor’s advice.
• 85 percent of Americans over 65 are confident in their doctor’s advice and 67 percent of those between 50 and 64 are confident, as are 65 percent of people under 50.

So, for now, we need to focus on undoing the damage of the Vitamin D heresy, the coconut oil for everything movement, and yes, even our mothers trusting the Internet more than us…but one can have faith that more trust (or more happy hours) will follow. n

—Neal Bhatia, MD

Chief Medical Editor