Dermatologists work extremely hard to gain the knowledge, skills, and training to provide excellent patient care; yet carrying out that mission isn’t always as simple as it should be. Practicing medicine in the real world means encountering many different barriers to care: patient access, insurance company mandates, and financial restrictions are just a few. Some days it can feel like you aren’t practicing medicine as much as you are in a demolition derby.
This is part of the health care world we live in today, and it is a far cry from the way we practiced medicine in the past. It can be extremely inspiring and heartening, however, to see some of the extreme effort doctors go through for their patients to ensure they receive quality care.
Our cover story this issue focuses on arguably one of the most challenging environments for practicing dermatology: safety net hospitals. Patients seen at these medical facilities of last resort often face hardships just getting to an appointment, which is why their skin disease frequently has progressed so far untreated. Then there are language and education barriers, medication adherence issues, and concurrent illnesses to treat before you can even address their skin disease. Interventions can make a difference in all these areas, though, as we explore beginning on page 36.
A more familiar struggle for most dermatologists may be the barriers we routinely face when trying to start or maintain a patient on biologics, as we discuss beginning on page 26. These drugs are so effective, yet so costly, that many patients who would benefit greatly from them are denied the opportunity to do so. Knowing how to navigate the insurance assistance programs many manufacturers generously offer can help, although that process is not without its frustrations.
Along with those frustrations, though, comes hope. In this issue, we also explore an alternative treatment for hair loss (page 24), the potential for bacteria to one day help manage atopic dermatitis (page 34), and how performing an oral exam can help diagnose cutaneous diseases (page 44). Dermatologists are a resilient bunch. Life keeps setting up barriers, but working together, we will keep knocking them down.
Steven R. Feldman, MD, PhD
Chief Medical Editor
Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.