Much has been said in the past few years about physician burnout. On top of the normal stressors of life, physicians may deal with a headache from electronic health records (EHR) and Centers for Medicare & Medicaid Services requirements. Some have sought salvage in early retirement and buyouts or mergers. Then came coronavirus disease (COVID-19)! It has not only threatened public health, but it has changed dermatologic practice as we know it.
Many offices have closed, hopefully to resume soon, and elective and cosmetic procedures are on hold. This is traumatic for us, both as dermatologists who enjoy the field and as business owners. We have turned to teledermatology, which has its own challenges and stresses, and adjusted to the new normal Zoom meetings in place of in-person events. Our organizations have done wonders using video conferencing for meetings and introducing online courses for review and residents. While long-distance learning can be useful, it cannot replace the individual, face-to-face interactions people get in classrooms, lecture halls, and in-person networking events. We understand the need for physical distancing, yet we all yearn for the warmth of personal interactions.
Missing the Patient
Going to the office is exciting—you never know exactly what you will find. The diversity of dermatology provides anticipation and happiness that is received and returned to students and patients.
There is joy when an interesting patient who has gone to numerous physicians presents to my office and I know I can finally help their skin issues. Take for example the woman with trepidation about returning for her senior year at college due to her out-of-control eczema. Dupilumab (Dupixent) as a therapy is only part of what it takes to make her happy. In fact, I am part of this equation of therapy: talking to her, reassuring her, going the extra mile since she waited until August, when preparing to return to school, to come to me.
It is also wonderful when patients say they look forward to coming to the office. They confide in me and share their good news. I recall feeling joy when a patient with Down syndrome was elated to see me and tell me about her new nephew. Sometimes, patients can rattle on with an unbelievable tale. I think of a woman who came to my office from a nursing home and claimed Hollywood wanted to make a movie about her life; she wrote many hits in the sixties, had affairs, and on and on. What a feeling of surprise and wonder when I took the entire staff to see the musical about her life on Broadway! Many of us have famous patients, but I thought this lady was senile; yet, I let her babble, learned an amazing backstory, and built a special relationship.
It’s these interactions that build patient-physician trust that are missing from my everyday now. Because we as dermatologists see mostly healthy patients and for many years, patients rely on our opinions about other matters and ask advice about their other health issues or those of their families, and even domestic disputes or life-changing decisions. My patients trust and value my opinion, and their respect is what gives me great satisfaction with my career.
All of us have patients whose outcomes make us feel proud. I learned a long time ago that it is not the compliment from a patient that makes a difference (patients are fickle); rather, it is the joy and satisfaction one gets from within. The joy and satisfaction are things you have to know and feel personally. It has to be part of you. A physician should recognize the understanding of what he or she means to the patient and to oneself.
Missing the Office
During the COVID-19 situation, we are only supposed to see “emergencies” in the office, but what is an emergency? The definition can vary based on the physician as well as by the individual patient. There must be thoughtfulness and heart in your decision to see patients.
I recently saw a patient with a history of melanoma who traveled over an hour to just see me. She developed a new bulging lesion and was terrified. Dermatologists near her home were temporarily closed, and she did not want to go into the city. So, for her case, we held a teleconference after I reviewed a picture of the lesion; however, I could not calm her until it was removed. The in-person excision, with recommended physical distancing procedures, gave the patient peace of mind and comfort. It also gave me happiness that I could do something for a patient on a personal level.
Even with this pandemic, I think most of us would rather reschedule an in-person appointment than do it virtually. It is the human aspect for both the patient and physician. Has a patient ever complained that he or she went to a physician who “didn’t even touch them” or looked at their lesion from “across the room”? This is what the in-person visit is all about.
There are those of us who find virtual meetings interesting and exciting. People who are quarantined have an urge to communicate with others, and teledermatology allows us to continue patient care. However, in an era of EHR and the decline of private practice, teledermatology cannot replace the in-person encounter. Physicians should continue to go the extra mile and ask questions of your patients that may help them and you. It is good history taking to ask the patient with acne on her chest if her gown for a prom or wedding is cut low to expose the area—how much longer does it take to ask the color as well? This extra step will go a long way for both you and your patients. Plus, the little details are what make life interesting.
Missing the Study
It brings me joy to teach students and others about dermatology. We are not just “pimple poppers” or “Botox providers”; we are physicians who change lives by relieving patients of worries and making them feel better. I treat a whole patient—the person—not just an eruption, a cancer, or a wrinkle. Dermatology is not as easy as interlopers think. I recently had a student who thought dermatology would be simple and a good way to make money. Her rotation through my practice exposed her to how dermatology really is and how I interact with my patients. At the end of her rotation, this student told me about her eye-awakening experience and said my office was the best one she had rotated through. Hearing her thanks brought me so much satisfaction and joy knowing I helped shape her career even slightly.
My father was a dentist for what felt like a hundred years, and I sometimes think I am turning into him. He saw generations of patients, and they thought of him as part of their families. I, too, see generations like my father and have similar experiences with patients. I think I owe it to my family’s lesson to take an interest in my patients as “people.” This is difficult in 2020, but when you put your heart and soul into it, the joy you receive is multiplied tenfold to see their diseases and conditions treated successfully.
In addition, it is a pleasure to give back to my field through society work and research studies. This is a way to go forward. I am proud to be a positive face of dermatology and an example for others while serving and doing my part.
Feeling the Loss
This brings me to burnout. After hearing about what I get out of practice and living through COVID-19 isolation, it is my great hope that each one of us will also realize what we are missing by not “seeing” patients and interacting with them. Maybe staying at home will recharge the batteries, and everyone who thought of retirement or selling out as an answer will appreciate how much they are missing. There are those who are glad they are not faced with the business situation that this pandemic has brought, but I sincerely believe most of us chose our field and this life because we enjoy what we do and relish the thought of returning to the office. Please note how I said office, not work, for this is not just work or a job; it is a career and a true love.
Unlike other fields of medicine, dermatology is diverse, interesting, and challenging. I am so happy and grateful to be a dermatologist that giving back and showing my appreciation brings me more joy than I can say. This sense of joy is not necessarily a feeling of accomplishment or pride, but it is exhilarating and has an infectious enthusiasm that circulates and affects everyone (ie, staff and patients) around you. The office has a positive atmosphere that boomerangs back to show in your practice. Given the current atmosphere, it is certainly a time to be positive.
In this way, one reaps what one sows. Without being able to go to the office and see patients, I am miserable during this pandemic. Dermatology is my vocation and my avocation. As every cloud should have a silver lining, may this pandemic be over and allow us all to return to seeing and helping our patients with a renewed vitality and vigor as both the patients and the physicians deserve.
Dr Marcus is a board-certified dermatologist in private practice in Wyckoff, NJ.
Disclosure: The author reports no relevant financial relationships.