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Spotlight on: Nicholas J. Golda, MD

Spotlight on: Nicholas J. Golda, MD

Dr Golda

Dr Golda is an associate professor of clinical dermatology at the University of Missouri School of Medicine. His practice focuses on Mohs micrographic surgery, facial reconstruction, cutaneous oncology, and laser procedures. 

As the medical director of the Dermatology Clinics at the University of Missouri Health System, Dr Golda focuses on performance and process improvement, team dynamics, and workplace culture all with the goal of improving both the patient and provider experience. He founded the University of Missouri Department of Dermatology’s first Accreditation Council for Graduate Medical Education fellowship training program. As the program director for the Micrographic Surgery and Dermatologic Oncology fellowship program, he enjoys training and mentoring the next generation of fellowship-trained dermatologic surgeons. He also collaborates with the bioengineering faculty at the University of Missouri on research aimed on improving the diagnosis and treatment of skin cancer and making office procedures such as laser and outpatient surgery safer and more efficient. This work has resulted in the development of exciting patented technology.

Dr Golda enjoys camping all over the United States with his wife and 2 daughters, gardening and working outdoors, and all of the other excitement that comes from trying to keep up with 2 little girls and a busy family.

Q. What part of your work gives you the most pleasure? 

A. The social interactions at all levels of my work are where I find the most pleasure. This includes daily interactions with patients, especially the casual conversations that we have with each other during procedures. Additionally, as a fellowship director, there is nothing more satisfying than being able to mentor a fellow through the process of mastering Mohs surgery. In my administrative role, I love the challenge of working with and motivating people to develop an effective team. I also thoroughly enjoy being engaged with my health system and having the opportunity to contribute to the growth and continuous improvement of a system that is relied on by so many people in central Missouri.

Q. Are an understanding and appreciation of the humanities important in dermatology and why?  

A. Thinking about the humanities as being the part of what we do that is less based on hard science and more based on human interaction. I would say that understanding and appreciating the humanities is not important, it is essential. The physician-patient interaction has been cluttered by so much regulation, restriction, and bad process that we now face an epidemic of physician burnout. Many of us grew up with a particular, possibly idyllic, image of what a physician was, and the modern practice of medicine has moved far from that image. The human interaction of being the physician who cares for a patient in need is at the heart of why most (if not all) of us went into medicine in the first place. We need to work to reorient health care toward the goal of supporting the patient-physician interaction and stripping away what confounds that interaction.    

Q. Who was your hero/mentor and why?

A. George Hruza, MD, is both to me in dermatology. He was there for me at a critical point in my life and I owe much of my success to his willingness to train me, invest in me, mentor me, and support my endeavors to this day. He gave me my first lessons not only about Mohs surgery but also practice management, diplomacy, and the importance of engaging on a local and national level in the house of medicine. We all owe a debt to people like him who give so much from their personal and professional time and resources to advance and advocate for our specialty.    

Learn more about Dr Golda on page 2

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Q. Which patient had the most effect on your work and why? 

A. My wife, who has dealt with several protracted courses of chronic autoimmune urticaria, has taught me a lot about how skin disease profoundly affects not only our patients’ quality of life, but the lives of the people around them. There is a lot of suffering that our patients with chronic diseases do outside of the 15 minutes we have with them in clinic. From her, I learned to really listen to what patients are saying about their experiences with health issues and that some conditions we treat do not always fit into the perfect boxes we have made up in our minds based on our education. Patients can intuit much about their own conditions and how they are uniquely affected, but in order to take advantage of this information as we try to help them we need to be open to hearing them out. The experience was also profoundly humbling, because in dermatology we know so much about skin disease, but even for a condition as common as urticaria, we still have limited solutions to offer and a lot left to learn.

Q. Which medical figure in history would you want to have a drink with and why?

A. I would love to have the opportunity to have a drink with Dr Stephen Bergman (Samuel Shem, the author of The House of God). I appreciated how he was able to shine light on what was wrong with medicine a generation ago. He cleverly did this through a stinging and uncomfortably funny satire. I would want to discuss how the story in The House of God would look in the context of contemporary issues in medicine because. While physicians and hospital systems have addressed many of the problems illustrated in his original work, I feel physicians are still isolated and patients and physicians alike are still depersonalized by systems within health care. Beyond all of this, my guess is that he would be fun to have a drink with—we would probably share some good laughs.  

Q. What is the greatest political danger in the field of dermatology?   

A.  I believe access to care is one of the primary dangers that the field of dermatology faces. We are all aware of the severe impact that skin disease has on our patients, but there are simply not enough dermatologists being trained to meet that need. The recently published burden of skin disease report in the Journal of the American Academy of Dermatology estimated a shortage of 10,000 dermatologists in the United States.1,2 When patients cannot see one of us in a timely manner, it opens the door for lesser-trained individuals to bill themselves as skin care specialists, which, without proper supervision by a dermatologist, can lead to bad outcomes for patients.  

Optimal patient care, both in terms of cost and quality, is provided when a patient with a dermatologic need is seen by a board-certified dermatologist or, when necessary, by a mid-level provider (nurse practitioner or physician assistant) under the direct supervision of a dermatologist. Further, the advent of electronic medical records and the increasing time consumed by regulatory compliance have prolonged the time it takes to see a patient and, I believe, are some of the primary drivers of physician burnout. These forces that serve to effectively shrink the dermatology workforce by either taking patient care time away from practicing dermatologists or by driving physicians into early retirement further compound the problem of patient access and serve to expose our patients to the risks associated with delayed treatment. 

References

1. Lim HW, Collins SAB, Resneck JS Jr, et al. The burden of skin disease in the United States. J Am Acad Dermatol. 2017;76(5):958-972.e2.

2. Edison K, Brod B. Commentary: burden of skin disease report: implications for dermatology. J Am Acad Dermatol. 2017;76(5):973-974.

Dr. Barankin

Dr Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.

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