User login
Rate This Column!
Our local Board of Registration in Medicine has a new requirement. To update a medical license, you have to take 3 hours of CME credit in opioid pain management, and another 2 hours in end-of-life issues. Fair enough. I prescribe OxyContin for my acne patients as often as the next dermatologist. As for end-of-life matters, a friend I told about the new regulation asked if I had many patients who wanted to end their lives. I said no, but I could think of a few patients who make me think about ending mine.
Anyhow, I took the courses as online webinars, featuring lecturers by academics from local medical institutions. Some of the information was likely to be helpful, at least for physicians in a position to use it often enough to remember it. Some was boilerplate, delivered in a monotone:
"As Sarkissian et al. found in a 2006 article published in the Journal of Annoying Interactions, 63% of patients seeking drugs may exhibit manipulative behavior." OK, thanks.
So you finish the webinar and take the post-module test. There are six questions, and you need to get four right. You pass. (Hooray!) Now you want to print out the CME certificate. But wait – first you have to take the Post Test Evaluation. So you click on the hyperlink, and there it is. The questions are in red, followed by open red circles. The first question is: How would you rate this presentation? 5 is Excellent, followed by Good, Fair, Poor, No Opinion, Not Applicable, and Nolo Contendere.
But here is the amazing part: 5 is already filled in! There’s a bright red circle staring you in the face. If you want to rate the presentation any way but Excellent, you have to change it by unclicking 5 and clicking a different circle.
In other words, they are not asking you to rate them Excellent. They are not telling you to rate them Excellent. They are doing it for you!
Surely, they must be kidding.
But they are not.
The other Evaluation questions range from irritating to inane:
• Did you find the presentation professional? (If you mark "No," you have to explain why. "I dunno, the shrink’s sport coat was kinda wrinkled.")
• Will it change your practice? (If you mark "Yes," you have to explain how. "I will not let patients manipulate me any more. Instead, I will hold my breath.")
• Did you find the presentation influenced by commercial considerations? ("Not really, except for the pop-up ads for methadone clinics.")
• Do you have any suggestions to improve future webinars? ("Maybe free opioid samples, so we can test out their half-lives for ourselves?")
So my by-default 5-ratings will be duly tabulated by little cyber-elves who live in statistical cyber-caverns, where they compile the data showing that the Massachusetts CME Consortium is indeed doing the Excellent Job that will entitle it to continue providing Continuing Education Courses of Excellence.
I don’t know how much any of this matters. Am I any smarter than I was before? Well, maybe in one way. Now I know what to do for myself:
Since you are reading this column, you have to rate it. The scale is from 1 to 5, with 5 being "Transcendent."
Please e-mail the editor of Skin & Allergy News. Tell her you want to give me a 6. Insist that she open a new category, so you can do it.
Never mind, I already told her, so we’re good.
You’re welcome, don’t mention it.
Dr. Rockoff practices dermatology in Brookline, Mass.
Our local Board of Registration in Medicine has a new requirement. To update a medical license, you have to take 3 hours of CME credit in opioid pain management, and another 2 hours in end-of-life issues. Fair enough. I prescribe OxyContin for my acne patients as often as the next dermatologist. As for end-of-life matters, a friend I told about the new regulation asked if I had many patients who wanted to end their lives. I said no, but I could think of a few patients who make me think about ending mine.
Anyhow, I took the courses as online webinars, featuring lecturers by academics from local medical institutions. Some of the information was likely to be helpful, at least for physicians in a position to use it often enough to remember it. Some was boilerplate, delivered in a monotone:
"As Sarkissian et al. found in a 2006 article published in the Journal of Annoying Interactions, 63% of patients seeking drugs may exhibit manipulative behavior." OK, thanks.
So you finish the webinar and take the post-module test. There are six questions, and you need to get four right. You pass. (Hooray!) Now you want to print out the CME certificate. But wait – first you have to take the Post Test Evaluation. So you click on the hyperlink, and there it is. The questions are in red, followed by open red circles. The first question is: How would you rate this presentation? 5 is Excellent, followed by Good, Fair, Poor, No Opinion, Not Applicable, and Nolo Contendere.
But here is the amazing part: 5 is already filled in! There’s a bright red circle staring you in the face. If you want to rate the presentation any way but Excellent, you have to change it by unclicking 5 and clicking a different circle.
In other words, they are not asking you to rate them Excellent. They are not telling you to rate them Excellent. They are doing it for you!
Surely, they must be kidding.
But they are not.
The other Evaluation questions range from irritating to inane:
• Did you find the presentation professional? (If you mark "No," you have to explain why. "I dunno, the shrink’s sport coat was kinda wrinkled.")
• Will it change your practice? (If you mark "Yes," you have to explain how. "I will not let patients manipulate me any more. Instead, I will hold my breath.")
• Did you find the presentation influenced by commercial considerations? ("Not really, except for the pop-up ads for methadone clinics.")
• Do you have any suggestions to improve future webinars? ("Maybe free opioid samples, so we can test out their half-lives for ourselves?")
So my by-default 5-ratings will be duly tabulated by little cyber-elves who live in statistical cyber-caverns, where they compile the data showing that the Massachusetts CME Consortium is indeed doing the Excellent Job that will entitle it to continue providing Continuing Education Courses of Excellence.
I don’t know how much any of this matters. Am I any smarter than I was before? Well, maybe in one way. Now I know what to do for myself:
Since you are reading this column, you have to rate it. The scale is from 1 to 5, with 5 being "Transcendent."
Please e-mail the editor of Skin & Allergy News. Tell her you want to give me a 6. Insist that she open a new category, so you can do it.
Never mind, I already told her, so we’re good.
You’re welcome, don’t mention it.
Dr. Rockoff practices dermatology in Brookline, Mass.
Our local Board of Registration in Medicine has a new requirement. To update a medical license, you have to take 3 hours of CME credit in opioid pain management, and another 2 hours in end-of-life issues. Fair enough. I prescribe OxyContin for my acne patients as often as the next dermatologist. As for end-of-life matters, a friend I told about the new regulation asked if I had many patients who wanted to end their lives. I said no, but I could think of a few patients who make me think about ending mine.
Anyhow, I took the courses as online webinars, featuring lecturers by academics from local medical institutions. Some of the information was likely to be helpful, at least for physicians in a position to use it often enough to remember it. Some was boilerplate, delivered in a monotone:
"As Sarkissian et al. found in a 2006 article published in the Journal of Annoying Interactions, 63% of patients seeking drugs may exhibit manipulative behavior." OK, thanks.
So you finish the webinar and take the post-module test. There are six questions, and you need to get four right. You pass. (Hooray!) Now you want to print out the CME certificate. But wait – first you have to take the Post Test Evaluation. So you click on the hyperlink, and there it is. The questions are in red, followed by open red circles. The first question is: How would you rate this presentation? 5 is Excellent, followed by Good, Fair, Poor, No Opinion, Not Applicable, and Nolo Contendere.
But here is the amazing part: 5 is already filled in! There’s a bright red circle staring you in the face. If you want to rate the presentation any way but Excellent, you have to change it by unclicking 5 and clicking a different circle.
In other words, they are not asking you to rate them Excellent. They are not telling you to rate them Excellent. They are doing it for you!
Surely, they must be kidding.
But they are not.
The other Evaluation questions range from irritating to inane:
• Did you find the presentation professional? (If you mark "No," you have to explain why. "I dunno, the shrink’s sport coat was kinda wrinkled.")
• Will it change your practice? (If you mark "Yes," you have to explain how. "I will not let patients manipulate me any more. Instead, I will hold my breath.")
• Did you find the presentation influenced by commercial considerations? ("Not really, except for the pop-up ads for methadone clinics.")
• Do you have any suggestions to improve future webinars? ("Maybe free opioid samples, so we can test out their half-lives for ourselves?")
So my by-default 5-ratings will be duly tabulated by little cyber-elves who live in statistical cyber-caverns, where they compile the data showing that the Massachusetts CME Consortium is indeed doing the Excellent Job that will entitle it to continue providing Continuing Education Courses of Excellence.
I don’t know how much any of this matters. Am I any smarter than I was before? Well, maybe in one way. Now I know what to do for myself:
Since you are reading this column, you have to rate it. The scale is from 1 to 5, with 5 being "Transcendent."
Please e-mail the editor of Skin & Allergy News. Tell her you want to give me a 6. Insist that she open a new category, so you can do it.
Never mind, I already told her, so we’re good.
You’re welcome, don’t mention it.
Dr. Rockoff practices dermatology in Brookline, Mass.
Cultural Sensitivity
In February I switched Kaleigh to adapalene because she said that tretinoin “was drying me out.” Yet, in June she’d stopped the adapalene “because it burned.”
“Did your face get red?” I asked.
“No, but it felt funny for a while after I put it on. So I went back to tretinoin.”
“But you said tretinoin dries you out.”
“It only does when the seasons change.”
Maybe you know what Kaleigh means. I don’t.
Patients often say they have “sensitive skin.” The traditional medical way to analyze this is physical: What conditions affect the cells, nerves, and blood vessels so skin looks and feels a certain way?
Another way to look at it is psychological: What about this person makes her or him pay attention to small changes in appearance or feeling?
I propose a third way: cultural. Whom does this person hang out with who experiences and describes sensations this way?
Aestheticians and patrons of skin care counters talk a lot about how their skin looks and feels in terms that sound strange in a medical context.
“I can’t use this moisturizer. It dries me out.”
Say what?
If patients on clindamycin lotion say it dries them out, I can protest in vain, “But it’s a moisturizer!” “It makes me feel dry,” they reply (or shiny or oily.) Saying this at the salon gets their money back, no questions asked, not just because it’s good business but because the aesthetician or clerk understands exactly what they mean and finds it quite reasonable.
I haven’t made a systematic study of cultural differences in the way people feel things on their skin. I just present several observations in the hope that someone might organize and make sense of them some day.
It’s known, for instance, that black patients may prefer moisturizers and hair pomades that a white patient would find too oily. Without moisturizing, black patients call their skin “ashy,” a word assumed to mean dry. It can’t be measured as dry, however, though it certainly feels that way to people who feel they have ashy skin.
The elderly often feel dry, too, though it’s far from established that they actually are: Wrinkling and itching don’t correlate with transepidermal water loss. From time immemorial, old age has been assumed to drain away vital body fluids. The elderly know they’re all dried out, so they feel that way.
The sexes differ too, in this as in so much else. Most women don’t feel right unless they’ve moisturized. (It wards off aging, they imagine.) Many men hate the feel of cream on their skin. Being of the male persuasion myself, I can testify that even the thought of applying sunscreen makes my flesh crawl; I have to grit my teeth to put it on.
I’m sure that, like me, you see long-married couples, where the wife says, “Look how dry he is, Doctor. Make him moisturize!” Hubby helplessly rolls his eyes. I mediate but do encourage him to eat his Cream of Wheat.
What do men and women “feel” that leads to their respective proclivities? I don’t know, but I’m pretty sure it won’t be found in the anatomy of sensory C fibers.
Likewise, I’m sure that you meet people with long-term rashes who are convinced they have “poison ivy” when they don’t. What makes them think so?
“It itches like poison ivy,” they insist. What does poison ivy itch like? I don’t know but they do, with great conviction. Somehow, not just appearances but sensations get diffused in the general culture. Something similar happens when patients diagnosed as not having zoster sigh with relief. “It burned just like shingles,” they say.
The other day I saw a woman with juicy, steroid-fed tinea corporis. “I’m sure it started as an insect bite,” she said. “How come?” I asked.
“It tingles,” she replied, “just like an insect bite.” Again, I don’t how an insect bite tingles, but she does.
Until someone explains all this, when one of my sensitive patients insists that the cream or pill I prescribed is drying them out or the moisturizer I suggested is “prunifying” them, I’ll just nod sagely and recommend something else that will, assuredly, not offend their sensitivities.
Usually works. I’m a sensitive guy.
In February I switched Kaleigh to adapalene because she said that tretinoin “was drying me out.” Yet, in June she’d stopped the adapalene “because it burned.”
“Did your face get red?” I asked.
“No, but it felt funny for a while after I put it on. So I went back to tretinoin.”
“But you said tretinoin dries you out.”
“It only does when the seasons change.”
Maybe you know what Kaleigh means. I don’t.
Patients often say they have “sensitive skin.” The traditional medical way to analyze this is physical: What conditions affect the cells, nerves, and blood vessels so skin looks and feels a certain way?
Another way to look at it is psychological: What about this person makes her or him pay attention to small changes in appearance or feeling?
I propose a third way: cultural. Whom does this person hang out with who experiences and describes sensations this way?
Aestheticians and patrons of skin care counters talk a lot about how their skin looks and feels in terms that sound strange in a medical context.
“I can’t use this moisturizer. It dries me out.”
Say what?
If patients on clindamycin lotion say it dries them out, I can protest in vain, “But it’s a moisturizer!” “It makes me feel dry,” they reply (or shiny or oily.) Saying this at the salon gets their money back, no questions asked, not just because it’s good business but because the aesthetician or clerk understands exactly what they mean and finds it quite reasonable.
I haven’t made a systematic study of cultural differences in the way people feel things on their skin. I just present several observations in the hope that someone might organize and make sense of them some day.
It’s known, for instance, that black patients may prefer moisturizers and hair pomades that a white patient would find too oily. Without moisturizing, black patients call their skin “ashy,” a word assumed to mean dry. It can’t be measured as dry, however, though it certainly feels that way to people who feel they have ashy skin.
The elderly often feel dry, too, though it’s far from established that they actually are: Wrinkling and itching don’t correlate with transepidermal water loss. From time immemorial, old age has been assumed to drain away vital body fluids. The elderly know they’re all dried out, so they feel that way.
The sexes differ too, in this as in so much else. Most women don’t feel right unless they’ve moisturized. (It wards off aging, they imagine.) Many men hate the feel of cream on their skin. Being of the male persuasion myself, I can testify that even the thought of applying sunscreen makes my flesh crawl; I have to grit my teeth to put it on.
I’m sure that, like me, you see long-married couples, where the wife says, “Look how dry he is, Doctor. Make him moisturize!” Hubby helplessly rolls his eyes. I mediate but do encourage him to eat his Cream of Wheat.
What do men and women “feel” that leads to their respective proclivities? I don’t know, but I’m pretty sure it won’t be found in the anatomy of sensory C fibers.
Likewise, I’m sure that you meet people with long-term rashes who are convinced they have “poison ivy” when they don’t. What makes them think so?
“It itches like poison ivy,” they insist. What does poison ivy itch like? I don’t know but they do, with great conviction. Somehow, not just appearances but sensations get diffused in the general culture. Something similar happens when patients diagnosed as not having zoster sigh with relief. “It burned just like shingles,” they say.
The other day I saw a woman with juicy, steroid-fed tinea corporis. “I’m sure it started as an insect bite,” she said. “How come?” I asked.
“It tingles,” she replied, “just like an insect bite.” Again, I don’t how an insect bite tingles, but she does.
Until someone explains all this, when one of my sensitive patients insists that the cream or pill I prescribed is drying them out or the moisturizer I suggested is “prunifying” them, I’ll just nod sagely and recommend something else that will, assuredly, not offend their sensitivities.
Usually works. I’m a sensitive guy.
In February I switched Kaleigh to adapalene because she said that tretinoin “was drying me out.” Yet, in June she’d stopped the adapalene “because it burned.”
“Did your face get red?” I asked.
“No, but it felt funny for a while after I put it on. So I went back to tretinoin.”
“But you said tretinoin dries you out.”
“It only does when the seasons change.”
Maybe you know what Kaleigh means. I don’t.
Patients often say they have “sensitive skin.” The traditional medical way to analyze this is physical: What conditions affect the cells, nerves, and blood vessels so skin looks and feels a certain way?
Another way to look at it is psychological: What about this person makes her or him pay attention to small changes in appearance or feeling?
I propose a third way: cultural. Whom does this person hang out with who experiences and describes sensations this way?
Aestheticians and patrons of skin care counters talk a lot about how their skin looks and feels in terms that sound strange in a medical context.
“I can’t use this moisturizer. It dries me out.”
Say what?
If patients on clindamycin lotion say it dries them out, I can protest in vain, “But it’s a moisturizer!” “It makes me feel dry,” they reply (or shiny or oily.) Saying this at the salon gets their money back, no questions asked, not just because it’s good business but because the aesthetician or clerk understands exactly what they mean and finds it quite reasonable.
I haven’t made a systematic study of cultural differences in the way people feel things on their skin. I just present several observations in the hope that someone might organize and make sense of them some day.
It’s known, for instance, that black patients may prefer moisturizers and hair pomades that a white patient would find too oily. Without moisturizing, black patients call their skin “ashy,” a word assumed to mean dry. It can’t be measured as dry, however, though it certainly feels that way to people who feel they have ashy skin.
The elderly often feel dry, too, though it’s far from established that they actually are: Wrinkling and itching don’t correlate with transepidermal water loss. From time immemorial, old age has been assumed to drain away vital body fluids. The elderly know they’re all dried out, so they feel that way.
The sexes differ too, in this as in so much else. Most women don’t feel right unless they’ve moisturized. (It wards off aging, they imagine.) Many men hate the feel of cream on their skin. Being of the male persuasion myself, I can testify that even the thought of applying sunscreen makes my flesh crawl; I have to grit my teeth to put it on.
I’m sure that, like me, you see long-married couples, where the wife says, “Look how dry he is, Doctor. Make him moisturize!” Hubby helplessly rolls his eyes. I mediate but do encourage him to eat his Cream of Wheat.
What do men and women “feel” that leads to their respective proclivities? I don’t know, but I’m pretty sure it won’t be found in the anatomy of sensory C fibers.
Likewise, I’m sure that you meet people with long-term rashes who are convinced they have “poison ivy” when they don’t. What makes them think so?
“It itches like poison ivy,” they insist. What does poison ivy itch like? I don’t know but they do, with great conviction. Somehow, not just appearances but sensations get diffused in the general culture. Something similar happens when patients diagnosed as not having zoster sigh with relief. “It burned just like shingles,” they say.
The other day I saw a woman with juicy, steroid-fed tinea corporis. “I’m sure it started as an insect bite,” she said. “How come?” I asked.
“It tingles,” she replied, “just like an insect bite.” Again, I don’t how an insect bite tingles, but she does.
Until someone explains all this, when one of my sensitive patients insists that the cream or pill I prescribed is drying them out or the moisturizer I suggested is “prunifying” them, I’ll just nod sagely and recommend something else that will, assuredly, not offend their sensitivities.
Usually works. I’m a sensitive guy.
Short Notice
"Doctor, thank you so much for seeing me on such short notice."
"When did you call for an appointment?"
"Two days ago."
"Sappho, in my office. Right now."
"What's the matter, Doctor?"
"My last patient called only 2 days ago and got an appointment."
"But you had an opening..."
"I know it, and you know it, but the whole world doesn't have to know it. What if my colleagues find out? When do we get Grisnelda's Mystery Shopper report?"
"At lunch, today."
"OK, Grisnelda, whenever you're ready."
"I made this quarter's calls to try getting appointments around town, Doctor."
"Excellent, Grisnelda. Did you use the untraceable cell phone?"
"Yes, and then I threw it in the Charles River just like they do in the Hudson on 'Law and Order.'"
"Great. What did you find?"
"Borromeo Dermatology has a 6-week wait, down from 7 last quarter. Birkenstock Integrative Cutaneous Wellness has 9 weeks, up from 8. Stanislavsky Skin is holding steady at 4 months."
"Stanislavsky only works Wednesday afternoons. What about the hospital clinics?"
"At Mount Saint Helen's they can see you in November."
"November of this year? By that time, you'll probably either be better or not care."
"And then of course there's UADLPSSCADLE."
"Who on earth is that?"
"That's the new name for Metroderm, the big group with offices all over. It stands for Urban Agglomeration for Dermatology, Laser, Plastic Surgery, Skin Care, Age Defiance, and Lifestyle Enhancement."
"Good heavens! How do they answer the phone?"
"'Urban Agglomeration - where, to whom, and toward what end may we direct your call?' They have a 3-month wait, and that's after dropping Medicaid and all the low-paying HMOs."
"We actually get some of their isotretinoin patients. They need to be confirmed on iPLEDGE once a month, but they can't fit them in for follow-up in less than two. Sappho, do you see how embarrassing this is? What kind of place must this practice be if you can be seen the day after tomorrow? Why would anybody want to get an appointment at a place where anybody can just call up and get an appointment?"
"But, Doctor..."
"Let me make this perfectly clear. If we let on that I have openings and the word gets out, then people will be unwilling to make appointments, and then I'll have openings. Do you follow?"
"Not exactly..."
"Well, thanks for your input, everybody. It's time for us to get back to work."
"Good afternoon, Mrs. Rabinowitz. My goodness, I haven't seen you in 4 years."
"I had a problem last summer, Doctor, but you were on vacation, and they told me I wouldn't be able to see you for 3 months."
"Three months! Mrs. Rabinowitz, in more than 30 years I have never had patients wait anywhere near that long. In fact..."
"Well, that's what the receptionist told me, Doctor. So I called another dermatologist down the street, and he took care of me the same day. Such a nice young man, too."
Dr. Rockoff writes the column, "Under My Skin," which regularly appears in Skin & Allergy News, an Elsevier publication. He practices dermatology in Brookline, Mass. To respond to this column, e-mail Dr. Rockoff at sknews@elsevier.com.
"Doctor, thank you so much for seeing me on such short notice."
"When did you call for an appointment?"
"Two days ago."
"Sappho, in my office. Right now."
"What's the matter, Doctor?"
"My last patient called only 2 days ago and got an appointment."
"But you had an opening..."
"I know it, and you know it, but the whole world doesn't have to know it. What if my colleagues find out? When do we get Grisnelda's Mystery Shopper report?"
"At lunch, today."
"OK, Grisnelda, whenever you're ready."
"I made this quarter's calls to try getting appointments around town, Doctor."
"Excellent, Grisnelda. Did you use the untraceable cell phone?"
"Yes, and then I threw it in the Charles River just like they do in the Hudson on 'Law and Order.'"
"Great. What did you find?"
"Borromeo Dermatology has a 6-week wait, down from 7 last quarter. Birkenstock Integrative Cutaneous Wellness has 9 weeks, up from 8. Stanislavsky Skin is holding steady at 4 months."
"Stanislavsky only works Wednesday afternoons. What about the hospital clinics?"
"At Mount Saint Helen's they can see you in November."
"November of this year? By that time, you'll probably either be better or not care."
"And then of course there's UADLPSSCADLE."
"Who on earth is that?"
"That's the new name for Metroderm, the big group with offices all over. It stands for Urban Agglomeration for Dermatology, Laser, Plastic Surgery, Skin Care, Age Defiance, and Lifestyle Enhancement."
"Good heavens! How do they answer the phone?"
"'Urban Agglomeration - where, to whom, and toward what end may we direct your call?' They have a 3-month wait, and that's after dropping Medicaid and all the low-paying HMOs."
"We actually get some of their isotretinoin patients. They need to be confirmed on iPLEDGE once a month, but they can't fit them in for follow-up in less than two. Sappho, do you see how embarrassing this is? What kind of place must this practice be if you can be seen the day after tomorrow? Why would anybody want to get an appointment at a place where anybody can just call up and get an appointment?"
"But, Doctor..."
"Let me make this perfectly clear. If we let on that I have openings and the word gets out, then people will be unwilling to make appointments, and then I'll have openings. Do you follow?"
"Not exactly..."
"Well, thanks for your input, everybody. It's time for us to get back to work."
"Good afternoon, Mrs. Rabinowitz. My goodness, I haven't seen you in 4 years."
"I had a problem last summer, Doctor, but you were on vacation, and they told me I wouldn't be able to see you for 3 months."
"Three months! Mrs. Rabinowitz, in more than 30 years I have never had patients wait anywhere near that long. In fact..."
"Well, that's what the receptionist told me, Doctor. So I called another dermatologist down the street, and he took care of me the same day. Such a nice young man, too."
Dr. Rockoff writes the column, "Under My Skin," which regularly appears in Skin & Allergy News, an Elsevier publication. He practices dermatology in Brookline, Mass. To respond to this column, e-mail Dr. Rockoff at sknews@elsevier.com.
"Doctor, thank you so much for seeing me on such short notice."
"When did you call for an appointment?"
"Two days ago."
"Sappho, in my office. Right now."
"What's the matter, Doctor?"
"My last patient called only 2 days ago and got an appointment."
"But you had an opening..."
"I know it, and you know it, but the whole world doesn't have to know it. What if my colleagues find out? When do we get Grisnelda's Mystery Shopper report?"
"At lunch, today."
"OK, Grisnelda, whenever you're ready."
"I made this quarter's calls to try getting appointments around town, Doctor."
"Excellent, Grisnelda. Did you use the untraceable cell phone?"
"Yes, and then I threw it in the Charles River just like they do in the Hudson on 'Law and Order.'"
"Great. What did you find?"
"Borromeo Dermatology has a 6-week wait, down from 7 last quarter. Birkenstock Integrative Cutaneous Wellness has 9 weeks, up from 8. Stanislavsky Skin is holding steady at 4 months."
"Stanislavsky only works Wednesday afternoons. What about the hospital clinics?"
"At Mount Saint Helen's they can see you in November."
"November of this year? By that time, you'll probably either be better or not care."
"And then of course there's UADLPSSCADLE."
"Who on earth is that?"
"That's the new name for Metroderm, the big group with offices all over. It stands for Urban Agglomeration for Dermatology, Laser, Plastic Surgery, Skin Care, Age Defiance, and Lifestyle Enhancement."
"Good heavens! How do they answer the phone?"
"'Urban Agglomeration - where, to whom, and toward what end may we direct your call?' They have a 3-month wait, and that's after dropping Medicaid and all the low-paying HMOs."
"We actually get some of their isotretinoin patients. They need to be confirmed on iPLEDGE once a month, but they can't fit them in for follow-up in less than two. Sappho, do you see how embarrassing this is? What kind of place must this practice be if you can be seen the day after tomorrow? Why would anybody want to get an appointment at a place where anybody can just call up and get an appointment?"
"But, Doctor..."
"Let me make this perfectly clear. If we let on that I have openings and the word gets out, then people will be unwilling to make appointments, and then I'll have openings. Do you follow?"
"Not exactly..."
"Well, thanks for your input, everybody. It's time for us to get back to work."
"Good afternoon, Mrs. Rabinowitz. My goodness, I haven't seen you in 4 years."
"I had a problem last summer, Doctor, but you were on vacation, and they told me I wouldn't be able to see you for 3 months."
"Three months! Mrs. Rabinowitz, in more than 30 years I have never had patients wait anywhere near that long. In fact..."
"Well, that's what the receptionist told me, Doctor. So I called another dermatologist down the street, and he took care of me the same day. Such a nice young man, too."
Dr. Rockoff writes the column, "Under My Skin," which regularly appears in Skin & Allergy News, an Elsevier publication. He practices dermatology in Brookline, Mass. To respond to this column, e-mail Dr. Rockoff at sknews@elsevier.com.
Show Me Your Paw
The man had an ordinary, American-sounding name. Let's call him Al Morse. Al lives in New Hampshire. It was midwinter when Al told me he was taking his wife dog sledding.
"Ever done the Iditarod?" I asked.
"Been to Alaska lots of times," he said. Then he added, "Thing is, my dogs only understand Ukrainian or Russian. You tell 'em 'Sit!' and they don't know what you're talking about. But say, 'Sydity!' and they sit right down.
"I learned how to talk to these dogs from my folks," said Al. "My people are from Dnepropetrovsk." He then launched into a series of (to me) flawlessly-accented Ukrainian sled-dog commands -- my favorite (though not in Ukrainian) being, "Show me your paw."
I doubt I'll ever ask a Slavic sled-dog to show me its paw, but knowing that Al does may give me insight if my team ever looks perplexed. Picking up tips like this helps me reflect on what a wonderful profession medicine can be. You meet people you'd never otherwise run into and find out about things they do that you never imagined existed, and couldn't make up.
Take Mr. Blanchard, a middle-aged gent not currently employed. He lives in Revere, Mass., just north of Boston. Mr. Blanchard, who has the kind of rolling baritone favored by earlier generations of radio announcers, has a deep love of two Old Testament books: Ecclesiastes and Job. That this pair is among the most depressing ever written does not dampen his enthusiasm for them. Mr. Blanchard said that he has committed to memory every available English translation of each. He will cite quotations at the drop of a hat, or even if a hat fails to drop.
Every morning at dawn Mr. Blanchard strides along Revere Beach and cries out the verses of Ecclesiastes and Job to the waves. This, he told me, does great things for his lungs and gets his day started out right, though what you would feel like doing with your day after digesting the wisdom of Job and Ecclesiastes is not clear. Perhaps having a doughnut?
"It's inspiring," said Mr. Blanchard, with gusto. "To look out over the waves and say, as Job did, 'All the rivers flow into the sea, yet the sea is not full.'"
That, I gently observed, was from Ecclesiastes. If you're going to limit your canon to two books, you might as well keep them straight.
I could not invent Mr. Blanchard. Yet I have met him.
And then, just the other day, Kevin came in with his mother. A wrestler, Kevin contracted a loathsome scalp infection that was now oozing south-by-southeast onto his forehead. Knowing how mothers often feel about their sons engaging in contact sports, I gibed, "How about taking up chess, Kevin?"
"I do chess boxing," he said, not missing a beat.
"What?"
"Chess boxing," he repeated. "It's really popular. First you make some chess moves, then you box, and you go back and forth. You win either by a checkmate or a knockout."
"What on Earth are you talking about?" I responded. I figured this kid for the slickest leg-puller I ever met, but he seemed quite sincere.
Later, I Googled "chess boxing," and wouldn't you know that it was right there on Wikipedia? (Where else?)
The article read: "Chess boxing is a hybrid sport which combines boxing with chess in alternating rounds. The sport began when Dutch artist Iepe Rubingh, inspired by fictional depictions by French comic book artist and filmmaker Enki Bilal, organized actual bouts. Chess boxing is now growing in popularity. Participants must be both skilled boxers and chess players, as a match may be won either way."
Are you going to tell me you didn't know about chess boxing? What do you do--spend all your time reading medical journals? You should get out more, or learn from your patients who do.
Ecclesiastes wrote that there is nothing new under the sun. I guess Ecclesiastes didn't know about chess boxing.
Dr. Rockoff practices dermatology in Brookline, Mass. To respond to this column, e-mail Dr. Rockoff at our editorial offices at sknews@elsevier.com.
The man had an ordinary, American-sounding name. Let's call him Al Morse. Al lives in New Hampshire. It was midwinter when Al told me he was taking his wife dog sledding.
"Ever done the Iditarod?" I asked.
"Been to Alaska lots of times," he said. Then he added, "Thing is, my dogs only understand Ukrainian or Russian. You tell 'em 'Sit!' and they don't know what you're talking about. But say, 'Sydity!' and they sit right down.
"I learned how to talk to these dogs from my folks," said Al. "My people are from Dnepropetrovsk." He then launched into a series of (to me) flawlessly-accented Ukrainian sled-dog commands -- my favorite (though not in Ukrainian) being, "Show me your paw."
I doubt I'll ever ask a Slavic sled-dog to show me its paw, but knowing that Al does may give me insight if my team ever looks perplexed. Picking up tips like this helps me reflect on what a wonderful profession medicine can be. You meet people you'd never otherwise run into and find out about things they do that you never imagined existed, and couldn't make up.
Take Mr. Blanchard, a middle-aged gent not currently employed. He lives in Revere, Mass., just north of Boston. Mr. Blanchard, who has the kind of rolling baritone favored by earlier generations of radio announcers, has a deep love of two Old Testament books: Ecclesiastes and Job. That this pair is among the most depressing ever written does not dampen his enthusiasm for them. Mr. Blanchard said that he has committed to memory every available English translation of each. He will cite quotations at the drop of a hat, or even if a hat fails to drop.
Every morning at dawn Mr. Blanchard strides along Revere Beach and cries out the verses of Ecclesiastes and Job to the waves. This, he told me, does great things for his lungs and gets his day started out right, though what you would feel like doing with your day after digesting the wisdom of Job and Ecclesiastes is not clear. Perhaps having a doughnut?
"It's inspiring," said Mr. Blanchard, with gusto. "To look out over the waves and say, as Job did, 'All the rivers flow into the sea, yet the sea is not full.'"
That, I gently observed, was from Ecclesiastes. If you're going to limit your canon to two books, you might as well keep them straight.
I could not invent Mr. Blanchard. Yet I have met him.
And then, just the other day, Kevin came in with his mother. A wrestler, Kevin contracted a loathsome scalp infection that was now oozing south-by-southeast onto his forehead. Knowing how mothers often feel about their sons engaging in contact sports, I gibed, "How about taking up chess, Kevin?"
"I do chess boxing," he said, not missing a beat.
"What?"
"Chess boxing," he repeated. "It's really popular. First you make some chess moves, then you box, and you go back and forth. You win either by a checkmate or a knockout."
"What on Earth are you talking about?" I responded. I figured this kid for the slickest leg-puller I ever met, but he seemed quite sincere.
Later, I Googled "chess boxing," and wouldn't you know that it was right there on Wikipedia? (Where else?)
The article read: "Chess boxing is a hybrid sport which combines boxing with chess in alternating rounds. The sport began when Dutch artist Iepe Rubingh, inspired by fictional depictions by French comic book artist and filmmaker Enki Bilal, organized actual bouts. Chess boxing is now growing in popularity. Participants must be both skilled boxers and chess players, as a match may be won either way."
Are you going to tell me you didn't know about chess boxing? What do you do--spend all your time reading medical journals? You should get out more, or learn from your patients who do.
Ecclesiastes wrote that there is nothing new under the sun. I guess Ecclesiastes didn't know about chess boxing.
Dr. Rockoff practices dermatology in Brookline, Mass. To respond to this column, e-mail Dr. Rockoff at our editorial offices at sknews@elsevier.com.
The man had an ordinary, American-sounding name. Let's call him Al Morse. Al lives in New Hampshire. It was midwinter when Al told me he was taking his wife dog sledding.
"Ever done the Iditarod?" I asked.
"Been to Alaska lots of times," he said. Then he added, "Thing is, my dogs only understand Ukrainian or Russian. You tell 'em 'Sit!' and they don't know what you're talking about. But say, 'Sydity!' and they sit right down.
"I learned how to talk to these dogs from my folks," said Al. "My people are from Dnepropetrovsk." He then launched into a series of (to me) flawlessly-accented Ukrainian sled-dog commands -- my favorite (though not in Ukrainian) being, "Show me your paw."
I doubt I'll ever ask a Slavic sled-dog to show me its paw, but knowing that Al does may give me insight if my team ever looks perplexed. Picking up tips like this helps me reflect on what a wonderful profession medicine can be. You meet people you'd never otherwise run into and find out about things they do that you never imagined existed, and couldn't make up.
Take Mr. Blanchard, a middle-aged gent not currently employed. He lives in Revere, Mass., just north of Boston. Mr. Blanchard, who has the kind of rolling baritone favored by earlier generations of radio announcers, has a deep love of two Old Testament books: Ecclesiastes and Job. That this pair is among the most depressing ever written does not dampen his enthusiasm for them. Mr. Blanchard said that he has committed to memory every available English translation of each. He will cite quotations at the drop of a hat, or even if a hat fails to drop.
Every morning at dawn Mr. Blanchard strides along Revere Beach and cries out the verses of Ecclesiastes and Job to the waves. This, he told me, does great things for his lungs and gets his day started out right, though what you would feel like doing with your day after digesting the wisdom of Job and Ecclesiastes is not clear. Perhaps having a doughnut?
"It's inspiring," said Mr. Blanchard, with gusto. "To look out over the waves and say, as Job did, 'All the rivers flow into the sea, yet the sea is not full.'"
That, I gently observed, was from Ecclesiastes. If you're going to limit your canon to two books, you might as well keep them straight.
I could not invent Mr. Blanchard. Yet I have met him.
And then, just the other day, Kevin came in with his mother. A wrestler, Kevin contracted a loathsome scalp infection that was now oozing south-by-southeast onto his forehead. Knowing how mothers often feel about their sons engaging in contact sports, I gibed, "How about taking up chess, Kevin?"
"I do chess boxing," he said, not missing a beat.
"What?"
"Chess boxing," he repeated. "It's really popular. First you make some chess moves, then you box, and you go back and forth. You win either by a checkmate or a knockout."
"What on Earth are you talking about?" I responded. I figured this kid for the slickest leg-puller I ever met, but he seemed quite sincere.
Later, I Googled "chess boxing," and wouldn't you know that it was right there on Wikipedia? (Where else?)
The article read: "Chess boxing is a hybrid sport which combines boxing with chess in alternating rounds. The sport began when Dutch artist Iepe Rubingh, inspired by fictional depictions by French comic book artist and filmmaker Enki Bilal, organized actual bouts. Chess boxing is now growing in popularity. Participants must be both skilled boxers and chess players, as a match may be won either way."
Are you going to tell me you didn't know about chess boxing? What do you do--spend all your time reading medical journals? You should get out more, or learn from your patients who do.
Ecclesiastes wrote that there is nothing new under the sun. I guess Ecclesiastes didn't know about chess boxing.
Dr. Rockoff practices dermatology in Brookline, Mass. To respond to this column, e-mail Dr. Rockoff at our editorial offices at sknews@elsevier.com.