Leaving Ohio

“Why, oh why, oh why, oh,” my mother used to sing when I was a kid, “Why did I ever leave Ohio?” That's one of those sentimental home-state songs, like “The Missouri Waltz,” “Stars Fell on Alabama,” “I Love New York,” and “See the USA in Your Chevrolet.”

I never had the chance to leave Ohio until last month, when I found myself in Columbus, addressing the Ohio Dermatological Association on its 25th anniversary. Since I started practice almost 30 years ago, that makes me, in a sense, dermatologically older than Ohio. In my talk, “37 Steps to a Successful Practice,” I tried to impart the deep wisdom of experience about how to get ahead in our changing practice environment.

Because 37 is a lot of steps, I limited my remarks to the most crucial: branding, marketing, self-promotion, intensive use of the Internet through creative placement of Web site keywords and Facebook networking, and of course, office decoration according to the principles of Feng Shui.

For some reason, my Ohio colleagues found these thoughtful suggestions laughable. They gave the same response to my innovative plan to make sure patients come back for regular skin checks: an inspection sticker, color-coded by month and affixed to the neck below the angle of the jaw with superglue. This would allow people to peer over the collar of friends and family and say, “Oh, look—you've expired!” Well, I thought it was a good idea. It might even help with pay for performance.

I'm just glad I'm not running for office. Who can predict the responses of these denizens of America's heartland?

Afterward, I had a chance to speak with some of my Ohio colleagues, who seemed to be a refreshingly down-to-earth group. One Mohs surgeon told me that he likes to quiz his fellows by asking them what they consider the most important part of an interview with a prospective patient. After they disgorge what they think he wants to hear (details of the procedure and so on), he shakes his head and says, “Nope. It's showing them you're a good guy who knows what he's doing.”

“I guess we all learn that when we get out in the world,” I said.

“A lot of us don't,” he replied.

The others I met were in practice in Columbus and around the state, mostly in large groups. Several told me that they practice general dermatology. Some seemed almost apologetic when they added that they don't do much cosmetic work, as though that meant they were somehow behind the curve. If so, apologies were unnecessary.

One can certainly get the impression from all the advertising and hype that dermatology is morphing into a species of cosmetic surgery or advanced aesthetics. I provide laser and cosmetic services, carried along like others by the tides of fashion and patient expectations, but I'm still not comfortable with this trend.

Among other things, laser and cosmetic work has brought the modes of marketing into our medical world: coupons, promotions, branding—that sort of thing.

Of course, marketing has made large inroads in traditional medical areas too. Within 10 minutes, the rock station I heard at the gym last week blared two promotions for prominent teaching hospitals providing orthopedic and psychiatric services.

Our sample closets fill with discount coupons to mitigate tiered copays, along with “bundled” products (buy this prescription topical, get this over-the-counter cleanser free!). Nothing wrong with any of this, perhaps, but it just highlights how blurry distinctions have become between medicine and retail.

I'm sure plenty of doctors in Ohio and throughout Middle America perform cosmetic procedures with skill and gusto. Just yesterday a Google ad popped up on my e-mail for a laser center in Indianapolis. (I booked a flight at once.)

It was nice, however, to meet a few colleagues whose practices are still mostly or entirely “just general derm.”

Getting patients to look younger and feel good about themselves is a worthy goal. Someone ought to be doing this. But helping sick people get better is, I think, the reason we went to medical school.

“Why, oh why, oh why, oh,” my mother used to sing when I was a kid, “Why did I ever leave Ohio?” That's one of those sentimental home-state songs, like “The Missouri Waltz,” “Stars Fell on Alabama,” “I Love New York,” and “See the USA in Your Chevrolet.”

I never had the chance to leave Ohio until last month, when I found myself in Columbus, addressing the Ohio Dermatological Association on its 25th anniversary. Since I started practice almost 30 years ago, that makes me, in a sense, dermatologically older than Ohio. In my talk, “37 Steps to a Successful Practice,” I tried to impart the deep wisdom of experience about how to get ahead in our changing practice environment.

Because 37 is a lot of steps, I limited my remarks to the most crucial: branding, marketing, self-promotion, intensive use of the Internet through creative placement of Web site keywords and Facebook networking, and of course, office decoration according to the principles of Feng Shui.

For some reason, my Ohio colleagues found these thoughtful suggestions laughable. They gave the same response to my innovative plan to make sure patients come back for regular skin checks: an inspection sticker, color-coded by month and affixed to the neck below the angle of the jaw with superglue. This would allow people to peer over the collar of friends and family and say, “Oh, look—you've expired!” Well, I thought it was a good idea. It might even help with pay for performance.

I'm just glad I'm not running for office. Who can predict the responses of these denizens of America's heartland?

Afterward, I had a chance to speak with some of my Ohio colleagues, who seemed to be a refreshingly down-to-earth group. One Mohs surgeon told me that he likes to quiz his fellows by asking them what they consider the most important part of an interview with a prospective patient. After they disgorge what they think he wants to hear (details of the procedure and so on), he shakes his head and says, “Nope. It's showing them you're a good guy who knows what he's doing.”

“I guess we all learn that when we get out in the world,” I said.

“A lot of us don't,” he replied.

The others I met were in practice in Columbus and around the state, mostly in large groups. Several told me that they practice general dermatology. Some seemed almost apologetic when they added that they don't do much cosmetic work, as though that meant they were somehow behind the curve. If so, apologies were unnecessary.

One can certainly get the impression from all the advertising and hype that dermatology is morphing into a species of cosmetic surgery or advanced aesthetics. I provide laser and cosmetic services, carried along like others by the tides of fashion and patient expectations, but I'm still not comfortable with this trend.

Among other things, laser and cosmetic work has brought the modes of marketing into our medical world: coupons, promotions, branding—that sort of thing.

Of course, marketing has made large inroads in traditional medical areas too. Within 10 minutes, the rock station I heard at the gym last week blared two promotions for prominent teaching hospitals providing orthopedic and psychiatric services.

Our sample closets fill with discount coupons to mitigate tiered copays, along with “bundled” products (buy this prescription topical, get this over-the-counter cleanser free!). Nothing wrong with any of this, perhaps, but it just highlights how blurry distinctions have become between medicine and retail.

I'm sure plenty of doctors in Ohio and throughout Middle America perform cosmetic procedures with skill and gusto. Just yesterday a Google ad popped up on my e-mail for a laser center in Indianapolis. (I booked a flight at once.)

It was nice, however, to meet a few colleagues whose practices are still mostly or entirely “just general derm.”

Getting patients to look younger and feel good about themselves is a worthy goal. Someone ought to be doing this. But helping sick people get better is, I think, the reason we went to medical school.

“Why, oh why, oh why, oh,” my mother used to sing when I was a kid, “Why did I ever leave Ohio?” That's one of those sentimental home-state songs, like “The Missouri Waltz,” “Stars Fell on Alabama,” “I Love New York,” and “See the USA in Your Chevrolet.”

I never had the chance to leave Ohio until last month, when I found myself in Columbus, addressing the Ohio Dermatological Association on its 25th anniversary. Since I started practice almost 30 years ago, that makes me, in a sense, dermatologically older than Ohio. In my talk, “37 Steps to a Successful Practice,” I tried to impart the deep wisdom of experience about how to get ahead in our changing practice environment.

Because 37 is a lot of steps, I limited my remarks to the most crucial: branding, marketing, self-promotion, intensive use of the Internet through creative placement of Web site keywords and Facebook networking, and of course, office decoration according to the principles of Feng Shui.

For some reason, my Ohio colleagues found these thoughtful suggestions laughable. They gave the same response to my innovative plan to make sure patients come back for regular skin checks: an inspection sticker, color-coded by month and affixed to the neck below the angle of the jaw with superglue. This would allow people to peer over the collar of friends and family and say, “Oh, look—you've expired!” Well, I thought it was a good idea. It might even help with pay for performance.

I'm just glad I'm not running for office. Who can predict the responses of these denizens of America's heartland?

Afterward, I had a chance to speak with some of my Ohio colleagues, who seemed to be a refreshingly down-to-earth group. One Mohs surgeon told me that he likes to quiz his fellows by asking them what they consider the most important part of an interview with a prospective patient. After they disgorge what they think he wants to hear (details of the procedure and so on), he shakes his head and says, “Nope. It's showing them you're a good guy who knows what he's doing.”

“I guess we all learn that when we get out in the world,” I said.

“A lot of us don't,” he replied.

The others I met were in practice in Columbus and around the state, mostly in large groups. Several told me that they practice general dermatology. Some seemed almost apologetic when they added that they don't do much cosmetic work, as though that meant they were somehow behind the curve. If so, apologies were unnecessary.

One can certainly get the impression from all the advertising and hype that dermatology is morphing into a species of cosmetic surgery or advanced aesthetics. I provide laser and cosmetic services, carried along like others by the tides of fashion and patient expectations, but I'm still not comfortable with this trend.

Among other things, laser and cosmetic work has brought the modes of marketing into our medical world: coupons, promotions, branding—that sort of thing.

Of course, marketing has made large inroads in traditional medical areas too. Within 10 minutes, the rock station I heard at the gym last week blared two promotions for prominent teaching hospitals providing orthopedic and psychiatric services.

Our sample closets fill with discount coupons to mitigate tiered copays, along with “bundled” products (buy this prescription topical, get this over-the-counter cleanser free!). Nothing wrong with any of this, perhaps, but it just highlights how blurry distinctions have become between medicine and retail.

I'm sure plenty of doctors in Ohio and throughout Middle America perform cosmetic procedures with skill and gusto. Just yesterday a Google ad popped up on my e-mail for a laser center in Indianapolis. (I booked a flight at once.)

It was nice, however, to meet a few colleagues whose practices are still mostly or entirely “just general derm.”

Getting patients to look younger and feel good about themselves is a worthy goal. Someone ought to be doing this. But helping sick people get better is, I think, the reason we went to medical school.