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Spotlight

Spotlight on: Iltefat Hamzavi, MD

October 2016

In dermatology, we are fortunate to have many insightful practitioners and great teachers and mentors. Some are bright stars in our special universe–others unsung heroes. All of these colleagues have much to share, from wisdom to humor to insights into dermatology and life. This column allows us to gain insight from these practitioners and learn more about them.

Iltefat Hamzavi , MD, is a metro Detroit-based dermatologist, family man, and community activist. He splits his time between the multicultural dermatology center at Henry Ford Hospital and Hamzavi Dermatology and its affiliate Dermatology Specialists. He is co-director of  the investigator initiated research unit at Henry Ford where they focus on pigmentary disorders, photomedicine, and hidradenitis suppurativa (HS). He also serves as the physician liaison for Hamzavi Dermatology and its affiliated groups.

Dr Hamzavi was born in Scotland to Indian/Pakistani parents and was raised in southeast Michigan. He went to medical school at University of Michigan and did his dermatology residency at Wayne State University followed by a photomedicine and laser fellowship at University of British Columbia. He comes from a family of dermatologists. His father and brother are dermatologists and his mother helped his father start and run Hamzavi Dermatology. He lives with his wife, Jabeen Siddiqui, and their 3 children in metro Detroit. His extended family is a big part of their lives and live throughout the region. They are passionate about their region and proud of its resilience during some very difficult times.

 

Q. Are an understanding and appreciation of the humanities important in dermatology and why?
A. An understanding and appreciation of the humanities is critical for any person. I would add the social sciences of sociology and political science to these fields and the ancient art of rhetoric. They provide tools to answer the questions of meaning and purpose. They provide tools to reconcile things in life that cannot be quantified. Questions like why am I doing this? Is this just? How much is too much? If you look at a hierarchy of tools, the humanities and philosophy are at the top of the organizational chart because these tools help craft the vision and mission statement. Science and math are tools that help execute the vision and mission statement. Dermatology is evolving into a team of people who care for patients. Society in some way or the other pays for a portion of that care. If you don’t understand the humanities, you cannot lead well and ultimately cannot care for your patient optimally. You cannot make the social case for the needs of your patient. You become a technician following a series of algorithms and lose a sense of control. If you master the humanities and associated fields, you can make your points and align your team toward a vision.

I have a deep love of history and biographies. I have often used analogy to understand what I am faced with and then tap into history to understand the broader trends of a situation and then the granular details of a human response to those situations. For example, implementing electronic health record has been very difficult. However, if you look back at the social disruptions caused by industrialization, you can see how you can cope with it well or poorly. You can also push back against it by developing systems with scribes to ensure you connect with your eyes to each patient and then interact with your scribe. You have a better medical record, you don’t lose the human connection, and you get to know your staff who is scribing better. If you engage your team and ask for better ways to improve the experience from your team, then you can follow the example of generative companies that were a response to the industrial revolution where there is a focus on the growth of every person who is part of any endeavor. Now you have taken a very tense and frustrating process and made it a positive experience where people have a sense of control. You are using accounting tools and technology tools but they are subsumed under your desire to serve the patient and care for your staff.

Q. What is your greatest regret?   
A. Not being patient enough with people. I have a sense of urgency about life and I don’t like waiting for change but I never want to demean anyone in the process. However, when your time controls you, it can affect your basic manners and respect for others. It is those same people who provide so much meaning and if you don’t take the time to appreciate them then you lose something.

Q. Who was your hero/mentor and why?
A. I have several that share a similar trait. My father and mother, my Imam (pastor) at the mosque I grew up in, Harvey Lui (chair at University of British Columbia in Vancouver), and Henry Lim (my chair at Henry Ford). All of them have the trait of fundamental human decency. They all have challenges but they almost always rise above them to do what is right. I have seen all of them go through trying times but they have never lost their affection for others and fundamentally find meaning and purpose in the growth of others.

Article continues on page 2

{{pagebreak}}

Q. Which patient had the most effect on your work and why?    
A. There are so many but the representative patient is a man who came from Pennsylvania to Detroit with severe HS. He had multiple surgeries that had disfigured him but he was still oozing pus from his buttocks, groin, and abdomen. He was also in tremendous pain. He and his wife would drive 8 hours with him lying in the back of their van because he could not sit down. He came to try to enroll in a study we were doing for the use of long-pulsed Nd: YAG laser for HS. It was for milder but persistent disease and his was too severe. Our research fellows were so very kind to him but told him there was nothing we could do. He was a large man (about 6 ft 5 in) with a high body mass index. He was an imposing presence. He came from rural Pennsylvania and there was a tremendous physical contrast between his demographic and the urban teaching hospital we work in.

I sat down with him and our fellows to talk and he looked at me trying to remain stoic and then his eyes welled up. Unlike many people, he did not turn away but looked me straight in the eye. As the tears were filling his eyes, he kept looking at me with a mix of rage and desperation. He said, “Doc no one else can help me. What else am I going to do? No one even cares. I just want someone to care. I just want to go fishing with my son.” I didn’t know what to do but I remembered a urology attending I had worked with who told me that sometimes when there is nothing you can do or say a touch can convey more. So I took my glove off and touched him on his shoulder to tell him there was nothing we could do. However, as I reached up to touch him something short circuited in my brain and I changed my message.

I remembered reading this biography about a Vietnam POW.  When this American POW asked how he got through his incarceration, he stated his fellow prisoner and commanding officer was also captured with him. His commander would always remind his fellow prisoners that they would get through their plight. He didn’t know how or when, but they would get through it. Now we are always taught in medicine to never give false hope to our patients, but I also feel we should never dash hope. Every culture values that element when coping with disease. So as I touched this man’s shoulder, I promised him that I, and the rest of our team would stay with him as long as he would like. We may not have a solution but we would care deeply and not give up. That was our promise.

He was our first patient we put on the combination antibiotic routine that is commonly used for HS patients and then he went on a biologic. He improved greatly and told me all he wanted to do was go fishing again in his boat. He just wanted to sit comfortably and enjoy a day of fishing. We almost got there, but after 4 years, he developed squamous cell carcinoma of the lung and passed away within 3 months of that diagnosis. He called me a few days before he died, and I apologized if anything we had done with his medications had caused his condition. He got upset and said that we had given him 4 years back and we never let go of our promise. We cared and we cared deeply.

When he passed away, his wife set up a collection at their church and they sent a donation of $1000 to our department to help with HS research. These are people of very limited means. Inside the envelope with the check was a note from his wife. It was a long note but the line I remember is “Thank you for giving him hope and thank you for caring.” I remember crying reading that note while also feeling a smile come across my face. I failed as a physician and researcher, but my patient helped me succeed as a human being. That night at evening prayers with our children, I asked them to pray for my patient and his family. I mentioned to my children how hard this was and how sad I was that my patient never got to go fishing. My older son was reading a biography about John F. Kennedy and his response was, “Dad, remember what JFK said, ‘We do these things (referencing the moonshot) not because they are easy but because they are hard.’” He then gave me a hug and reminded me how the humanities provide solace even through profound loss. They provide the tools to go on despite the hurdles.

Currently, Henry Ford Hospital is one of the largest centers for the care of HS in the world. It is also home to an active patient support group and I am the incoming President of the HS Foundation. Every one of our faculty and residents can manage HS with a multidisciplinary team. It has been very hard getting here and we need to do so much more.  However, I always remember the man who just wanted to go fishing. I hope we as a specialty can contribute in some way to allow all these wonderful patients to enjoy that time that makes life worth living.

Q. What is the best piece of advice you have received and from whom?   
A. My internist father-in-law once said, “Care for the patient with all you have and the money and respect will follow. If you chase the money, the patients will all run away from you.”

Q. Which medical figure in history would you want to have a drink with and why?   
A. Avicenna (Ibn Sina in the east). He was able to reconcile so many different philosophies of medicine while also writing, teaching, and seeing patients. The way he organized the topics in medicine is still with us today. 

 

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.

 

Online Extra
Visit The Dermatologist website: www.the-dermatologist.com to read more with Dr Hamzavi.

In dermatology, we are fortunate to have many insightful practitioners and great teachers and mentors. Some are bright stars in our special universe–others unsung heroes. All of these colleagues have much to share, from wisdom to humor to insights into dermatology and life. This column allows us to gain insight from these practitioners and learn more about them.

Iltefat Hamzavi , MD, is a metro Detroit-based dermatologist, family man, and community activist. He splits his time between the multicultural dermatology center at Henry Ford Hospital and Hamzavi Dermatology and its affiliate Dermatology Specialists. He is co-director of  the investigator initiated research unit at Henry Ford where they focus on pigmentary disorders, photomedicine, and hidradenitis suppurativa (HS). He also serves as the physician liaison for Hamzavi Dermatology and its affiliated groups.

Dr Hamzavi was born in Scotland to Indian/Pakistani parents and was raised in southeast Michigan. He went to medical school at University of Michigan and did his dermatology residency at Wayne State University followed by a photomedicine and laser fellowship at University of British Columbia. He comes from a family of dermatologists. His father and brother are dermatologists and his mother helped his father start and run Hamzavi Dermatology. He lives with his wife, Jabeen Siddiqui, and their 3 children in metro Detroit. His extended family is a big part of their lives and live throughout the region. They are passionate about their region and proud of its resilience during some very difficult times.

 

Q. Are an understanding and appreciation of the humanities important in dermatology and why?
A. An understanding and appreciation of the humanities is critical for any person. I would add the social sciences of sociology and political science to these fields and the ancient art of rhetoric. They provide tools to answer the questions of meaning and purpose. They provide tools to reconcile things in life that cannot be quantified. Questions like why am I doing this? Is this just? How much is too much? If you look at a hierarchy of tools, the humanities and philosophy are at the top of the organizational chart because these tools help craft the vision and mission statement. Science and math are tools that help execute the vision and mission statement. Dermatology is evolving into a team of people who care for patients. Society in some way or the other pays for a portion of that care. If you don’t understand the humanities, you cannot lead well and ultimately cannot care for your patient optimally. You cannot make the social case for the needs of your patient. You become a technician following a series of algorithms and lose a sense of control. If you master the humanities and associated fields, you can make your points and align your team toward a vision.

I have a deep love of history and biographies. I have often used analogy to understand what I am faced with and then tap into history to understand the broader trends of a situation and then the granular details of a human response to those situations. For example, implementing electronic health record has been very difficult. However, if you look back at the social disruptions caused by industrialization, you can see how you can cope with it well or poorly. You can also push back against it by developing systems with scribes to ensure you connect with your eyes to each patient and then interact with your scribe. You have a better medical record, you don’t lose the human connection, and you get to know your staff who is scribing better. If you engage your team and ask for better ways to improve the experience from your team, then you can follow the example of generative companies that were a response to the industrial revolution where there is a focus on the growth of every person who is part of any endeavor. Now you have taken a very tense and frustrating process and made it a positive experience where people have a sense of control. You are using accounting tools and technology tools but they are subsumed under your desire to serve the patient and care for your staff.

Q. What is your greatest regret?   
A. Not being patient enough with people. I have a sense of urgency about life and I don’t like waiting for change but I never want to demean anyone in the process. However, when your time controls you, it can affect your basic manners and respect for others. It is those same people who provide so much meaning and if you don’t take the time to appreciate them then you lose something.

Q. Who was your hero/mentor and why?
A. I have several that share a similar trait. My father and mother, my Imam (pastor) at the mosque I grew up in, Harvey Lui (chair at University of British Columbia in Vancouver), and Henry Lim (my chair at Henry Ford). All of them have the trait of fundamental human decency. They all have challenges but they almost always rise above them to do what is right. I have seen all of them go through trying times but they have never lost their affection for others and fundamentally find meaning and purpose in the growth of others.

Article continues on page 2

{{pagebreak}}

Q. Which patient had the most effect on your work and why?    
A. There are so many but the representative patient is a man who came from Pennsylvania to Detroit with severe HS. He had multiple surgeries that had disfigured him but he was still oozing pus from his buttocks, groin, and abdomen. He was also in tremendous pain. He and his wife would drive 8 hours with him lying in the back of their van because he could not sit down. He came to try to enroll in a study we were doing for the use of long-pulsed Nd: YAG laser for HS. It was for milder but persistent disease and his was too severe. Our research fellows were so very kind to him but told him there was nothing we could do. He was a large man (about 6 ft 5 in) with a high body mass index. He was an imposing presence. He came from rural Pennsylvania and there was a tremendous physical contrast between his demographic and the urban teaching hospital we work in.

I sat down with him and our fellows to talk and he looked at me trying to remain stoic and then his eyes welled up. Unlike many people, he did not turn away but looked me straight in the eye. As the tears were filling his eyes, he kept looking at me with a mix of rage and desperation. He said, “Doc no one else can help me. What else am I going to do? No one even cares. I just want someone to care. I just want to go fishing with my son.” I didn’t know what to do but I remembered a urology attending I had worked with who told me that sometimes when there is nothing you can do or say a touch can convey more. So I took my glove off and touched him on his shoulder to tell him there was nothing we could do. However, as I reached up to touch him something short circuited in my brain and I changed my message.

I remembered reading this biography about a Vietnam POW.  When this American POW asked how he got through his incarceration, he stated his fellow prisoner and commanding officer was also captured with him. His commander would always remind his fellow prisoners that they would get through their plight. He didn’t know how or when, but they would get through it. Now we are always taught in medicine to never give false hope to our patients, but I also feel we should never dash hope. Every culture values that element when coping with disease. So as I touched this man’s shoulder, I promised him that I, and the rest of our team would stay with him as long as he would like. We may not have a solution but we would care deeply and not give up. That was our promise.

He was our first patient we put on the combination antibiotic routine that is commonly used for HS patients and then he went on a biologic. He improved greatly and told me all he wanted to do was go fishing again in his boat. He just wanted to sit comfortably and enjoy a day of fishing. We almost got there, but after 4 years, he developed squamous cell carcinoma of the lung and passed away within 3 months of that diagnosis. He called me a few days before he died, and I apologized if anything we had done with his medications had caused his condition. He got upset and said that we had given him 4 years back and we never let go of our promise. We cared and we cared deeply.

When he passed away, his wife set up a collection at their church and they sent a donation of $1000 to our department to help with HS research. These are people of very limited means. Inside the envelope with the check was a note from his wife. It was a long note but the line I remember is “Thank you for giving him hope and thank you for caring.” I remember crying reading that note while also feeling a smile come across my face. I failed as a physician and researcher, but my patient helped me succeed as a human being. That night at evening prayers with our children, I asked them to pray for my patient and his family. I mentioned to my children how hard this was and how sad I was that my patient never got to go fishing. My older son was reading a biography about John F. Kennedy and his response was, “Dad, remember what JFK said, ‘We do these things (referencing the moonshot) not because they are easy but because they are hard.’” He then gave me a hug and reminded me how the humanities provide solace even through profound loss. They provide the tools to go on despite the hurdles.

Currently, Henry Ford Hospital is one of the largest centers for the care of HS in the world. It is also home to an active patient support group and I am the incoming President of the HS Foundation. Every one of our faculty and residents can manage HS with a multidisciplinary team. It has been very hard getting here and we need to do so much more.  However, I always remember the man who just wanted to go fishing. I hope we as a specialty can contribute in some way to allow all these wonderful patients to enjoy that time that makes life worth living.

Q. What is the best piece of advice you have received and from whom?   
A. My internist father-in-law once said, “Care for the patient with all you have and the money and respect will follow. If you chase the money, the patients will all run away from you.”

Q. Which medical figure in history would you want to have a drink with and why?   
A. Avicenna (Ibn Sina in the east). He was able to reconcile so many different philosophies of medicine while also writing, teaching, and seeing patients. The way he organized the topics in medicine is still with us today. 

 

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.

 

Online Extra
Visit The Dermatologist website: www.the-dermatologist.com to read more with Dr Hamzavi.

In dermatology, we are fortunate to have many insightful practitioners and great teachers and mentors. Some are bright stars in our special universe–others unsung heroes. All of these colleagues have much to share, from wisdom to humor to insights into dermatology and life. This column allows us to gain insight from these practitioners and learn more about them.

Iltefat Hamzavi , MD, is a metro Detroit-based dermatologist, family man, and community activist. He splits his time between the multicultural dermatology center at Henry Ford Hospital and Hamzavi Dermatology and its affiliate Dermatology Specialists. He is co-director of  the investigator initiated research unit at Henry Ford where they focus on pigmentary disorders, photomedicine, and hidradenitis suppurativa (HS). He also serves as the physician liaison for Hamzavi Dermatology and its affiliated groups.

Dr Hamzavi was born in Scotland to Indian/Pakistani parents and was raised in southeast Michigan. He went to medical school at University of Michigan and did his dermatology residency at Wayne State University followed by a photomedicine and laser fellowship at University of British Columbia. He comes from a family of dermatologists. His father and brother are dermatologists and his mother helped his father start and run Hamzavi Dermatology. He lives with his wife, Jabeen Siddiqui, and their 3 children in metro Detroit. His extended family is a big part of their lives and live throughout the region. They are passionate about their region and proud of its resilience during some very difficult times.

 

Q. Are an understanding and appreciation of the humanities important in dermatology and why?
A. An understanding and appreciation of the humanities is critical for any person. I would add the social sciences of sociology and political science to these fields and the ancient art of rhetoric. They provide tools to answer the questions of meaning and purpose. They provide tools to reconcile things in life that cannot be quantified. Questions like why am I doing this? Is this just? How much is too much? If you look at a hierarchy of tools, the humanities and philosophy are at the top of the organizational chart because these tools help craft the vision and mission statement. Science and math are tools that help execute the vision and mission statement. Dermatology is evolving into a team of people who care for patients. Society in some way or the other pays for a portion of that care. If you don’t understand the humanities, you cannot lead well and ultimately cannot care for your patient optimally. You cannot make the social case for the needs of your patient. You become a technician following a series of algorithms and lose a sense of control. If you master the humanities and associated fields, you can make your points and align your team toward a vision.

I have a deep love of history and biographies. I have often used analogy to understand what I am faced with and then tap into history to understand the broader trends of a situation and then the granular details of a human response to those situations. For example, implementing electronic health record has been very difficult. However, if you look back at the social disruptions caused by industrialization, you can see how you can cope with it well or poorly. You can also push back against it by developing systems with scribes to ensure you connect with your eyes to each patient and then interact with your scribe. You have a better medical record, you don’t lose the human connection, and you get to know your staff who is scribing better. If you engage your team and ask for better ways to improve the experience from your team, then you can follow the example of generative companies that were a response to the industrial revolution where there is a focus on the growth of every person who is part of any endeavor. Now you have taken a very tense and frustrating process and made it a positive experience where people have a sense of control. You are using accounting tools and technology tools but they are subsumed under your desire to serve the patient and care for your staff.

Q. What is your greatest regret?   
A. Not being patient enough with people. I have a sense of urgency about life and I don’t like waiting for change but I never want to demean anyone in the process. However, when your time controls you, it can affect your basic manners and respect for others. It is those same people who provide so much meaning and if you don’t take the time to appreciate them then you lose something.

Q. Who was your hero/mentor and why?
A. I have several that share a similar trait. My father and mother, my Imam (pastor) at the mosque I grew up in, Harvey Lui (chair at University of British Columbia in Vancouver), and Henry Lim (my chair at Henry Ford). All of them have the trait of fundamental human decency. They all have challenges but they almost always rise above them to do what is right. I have seen all of them go through trying times but they have never lost their affection for others and fundamentally find meaning and purpose in the growth of others.

Article continues on page 2

{{pagebreak}}

Q. Which patient had the most effect on your work and why?    
A. There are so many but the representative patient is a man who came from Pennsylvania to Detroit with severe HS. He had multiple surgeries that had disfigured him but he was still oozing pus from his buttocks, groin, and abdomen. He was also in tremendous pain. He and his wife would drive 8 hours with him lying in the back of their van because he could not sit down. He came to try to enroll in a study we were doing for the use of long-pulsed Nd: YAG laser for HS. It was for milder but persistent disease and his was too severe. Our research fellows were so very kind to him but told him there was nothing we could do. He was a large man (about 6 ft 5 in) with a high body mass index. He was an imposing presence. He came from rural Pennsylvania and there was a tremendous physical contrast between his demographic and the urban teaching hospital we work in.

I sat down with him and our fellows to talk and he looked at me trying to remain stoic and then his eyes welled up. Unlike many people, he did not turn away but looked me straight in the eye. As the tears were filling his eyes, he kept looking at me with a mix of rage and desperation. He said, “Doc no one else can help me. What else am I going to do? No one even cares. I just want someone to care. I just want to go fishing with my son.” I didn’t know what to do but I remembered a urology attending I had worked with who told me that sometimes when there is nothing you can do or say a touch can convey more. So I took my glove off and touched him on his shoulder to tell him there was nothing we could do. However, as I reached up to touch him something short circuited in my brain and I changed my message.

I remembered reading this biography about a Vietnam POW.  When this American POW asked how he got through his incarceration, he stated his fellow prisoner and commanding officer was also captured with him. His commander would always remind his fellow prisoners that they would get through their plight. He didn’t know how or when, but they would get through it. Now we are always taught in medicine to never give false hope to our patients, but I also feel we should never dash hope. Every culture values that element when coping with disease. So as I touched this man’s shoulder, I promised him that I, and the rest of our team would stay with him as long as he would like. We may not have a solution but we would care deeply and not give up. That was our promise.

He was our first patient we put on the combination antibiotic routine that is commonly used for HS patients and then he went on a biologic. He improved greatly and told me all he wanted to do was go fishing again in his boat. He just wanted to sit comfortably and enjoy a day of fishing. We almost got there, but after 4 years, he developed squamous cell carcinoma of the lung and passed away within 3 months of that diagnosis. He called me a few days before he died, and I apologized if anything we had done with his medications had caused his condition. He got upset and said that we had given him 4 years back and we never let go of our promise. We cared and we cared deeply.

When he passed away, his wife set up a collection at their church and they sent a donation of $1000 to our department to help with HS research. These are people of very limited means. Inside the envelope with the check was a note from his wife. It was a long note but the line I remember is “Thank you for giving him hope and thank you for caring.” I remember crying reading that note while also feeling a smile come across my face. I failed as a physician and researcher, but my patient helped me succeed as a human being. That night at evening prayers with our children, I asked them to pray for my patient and his family. I mentioned to my children how hard this was and how sad I was that my patient never got to go fishing. My older son was reading a biography about John F. Kennedy and his response was, “Dad, remember what JFK said, ‘We do these things (referencing the moonshot) not because they are easy but because they are hard.’” He then gave me a hug and reminded me how the humanities provide solace even through profound loss. They provide the tools to go on despite the hurdles.

Currently, Henry Ford Hospital is one of the largest centers for the care of HS in the world. It is also home to an active patient support group and I am the incoming President of the HS Foundation. Every one of our faculty and residents can manage HS with a multidisciplinary team. It has been very hard getting here and we need to do so much more.  However, I always remember the man who just wanted to go fishing. I hope we as a specialty can contribute in some way to allow all these wonderful patients to enjoy that time that makes life worth living.

Q. What is the best piece of advice you have received and from whom?   
A. My internist father-in-law once said, “Care for the patient with all you have and the money and respect will follow. If you chase the money, the patients will all run away from you.”

Q. Which medical figure in history would you want to have a drink with and why?   
A. Avicenna (Ibn Sina in the east). He was able to reconcile so many different philosophies of medicine while also writing, teaching, and seeing patients. The way he organized the topics in medicine is still with us today. 

 

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.

 

Online Extra
Visit The Dermatologist website: www.the-dermatologist.com to read more with Dr Hamzavi.

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