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A Conversation With James D. Walker, MD, FRCPC

A Conversation With James D. Walker, MD, FRCPC

Dr Jim WalkerDr James “Jim” Walker was born and grew up in Hamilton, Ontario, Canada. He graduated from medicine with honors from the University of Western Ontario (now Western University) in London, Ontario, in 1974. Following graduation, he completed his residency in dermatology in Ottawa, Ontario, as well as in Glasgow, Scotland. He returned to Ottawa and was in private practice for 28 years with Dr Nordau D. Kanigsberg. Dr Walker became an academic at the University of Ottawa in 2008, which he continued to do full-time until 2017.  

He was head of the division of dermatology at the University of Ottawa and Ottawa Hospital from 2003 to 2013 and later served as interim head from 2015 to 2017. His medical interests include internal medicine in dermatology, pediatric dermatology, skin cancer, cutaneous surgery, and teledermatology.

Dr Walker was a founding member of Physicians for a Smoke-Free Canada, a national organization seeking to reduce tobacco-caused illnesses, and a member of the 1972 Olympic Rowing team for Canada. He is married to Dr Louise Walker, and together they have 2 children and 2 grandchildren.  

He is now semiretired, but Dr Walker is still teaching and doing teledermatology.  

Q. What part of your work gives you the most pleasure?
Many aspects of dermatology have given me great pleasure over my career, from making an unusual diagnosis to meeting unusual and exceptional people. Probably my greatest rush on the surgical side has come from recognizing and treating skin cancers, particularly melanoma. On the medical side, it would be treating acne well.  

Q. What is the greatest political danger in the field of dermatology?
The single greatest danger is the influx of nonexperts or non-dermatologists masquerading as skin specialists. It is such a paradox that as we have embraced and adopted evidence-based medicine, particularly over the past 20 years or so, the explosion of nonexperts and false information have proliferated exponentially and threatens optimal patient care.

Q. Are an understanding and appreciation of the humanities important in dermatology and why?
The humanities are extremely important in dermatology. Many or our patients’ conditions are visible and embarrassing or humiliating to them. We must be supportive and advocate for our patients. Probably the single greatest pharmacologic advance during my career was the development and introduction of oral isotretinoin (Accutane) for severe acne. It was so thrilling to see depressed, involuted adolescents become so much more confident and engaged as their acne improved and stayed clear after completing isotretinoin. But we also need to be sensitive and supportive to the child with deforming vascular malformations, the stressed worker with compulsive excoriations, and the young lady dying of metastatic melanoma.  

Q. What is your greatest regret?   
I really don’t have many regrets. Dermatology has been a wonderful career. I have been a sort of “no trump” dermatologist with interest in many fields. I have enjoyed both medical and surgical dermatology, teaching, and leadership.  

If I were to do it over again, or give advice to a newly minted dermatologist, it would be to develop a specific area of expertise while maintaining interest and strength in the broader scope of dermatology.  

Q. Who was your hero/mentor and why? 
Dr Robert Jackson, who unfortunately passed away last March, was my major professional mentor, as he was to many others. He led by example. He put the patient first. He pioneered our skin cancer multidisciplinary clinic in the late 1950s. He advocated for the less privileged. He had an infectious curiosity, and he was the master of morphology. He published many studies and innovative articles while running a busy private practice, managing a heavy teaching load, and volunteering his time to our institutions in dermatology.  

Q. Which patient had the most effect on your work and why? 
It was probably the 16-year-old female patient whom I saw at a peripheral clinic with bad facial acne in the pre-isotretinoin era. I put her on minocycline for her acne. About 3 weeks later I received a call that she was in the hospital under neurology with a serious condition, pseudotumor cerebri, caused by the minocycline I had prescribed. I went to see her in the hospital. The neurologist had quite appropriately stopped her minocycline, and the patient was improving. However, the patient’s mother was quite hostile that I had prescribed this drug. The patient’s only concern was how I would treat her acne, now that she could not take minocycline. This girl really crystalized my mind with the importance of treating acne effectively and well.  

Q. What is the best piece of advice you have received and from whom?
A. Again, this came from Dr Jackson: “When you are caught in a conflict, do what is right for the patient.” The second piece of advice he gave me was “Develop good habits.” He wanted to preserve his brain for original and complex thoughts, not the mundane repetitive aspects of life.

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