- Email: [email protected]
Dermatology in dermatologic surgery
Volume 13 Number 6 December, 1985 improved sleep habits, including decrease in nightmare activity. These probably represented central effects of doxepin, in addition to improving some of the patients' chronic urticaria by this mechanism. Perhaps future study of the clinical usefulness of doxepin will lead to a better understanding of how it works in the dermatologic armamentarium.
Steven L. Greene, M.D., Dermatology Department Group Health Cooperative of Puget Sound Olive Way Medical Center 509 Olive Way Suite 555, Seattle, WA 98101
Dermatology in dermatologic surgery To the Editor: This letter is written to compliment Dr. Dobson on his editorial, "Medicine and the Marketplace," in the June 1985 issue of the JOURNAL. He has attempted to address the new area of interest for all practitioners of dermatology, marketing. Advertising has always been a degrading word for the physician, and it has been replaced by the more palatable and encompassing word, marketing. The physician who survives in the future assault on fee-for-service medicine as traditionally practiced will be the one who has finely tuned his practice to incorporate new self-marketing technics, i.e., excellence in medical care, patient enhancements, patient surveys, focus groups, recalls, patient referral recognition, establishing patient corridors, and establishing market presence. The last phase of self-marketing would be direct advertising of the individual to the public. If advertising directly to the public is to be undertaken, then I believe it should be done for the corporate body of dermatology and not for an individual. This aspect of the future practice of dermatology in its relationship to the marketplace was not addressed. Self-marketing should be a high priority item for the American Academy of Dermatology's use of the funds generated by the recent assessment for public relations. In the last paragraph of his editorial, Dr. Dobson is again verbalizing the atavistic thinking that dermatology is a subspecialty of medicine and loosely associating dermatologic surgery with the more limited area of cosmetic surgery. Please do not confuse the core of dermatologic surgical skills with the more advanced dermatologic surgery procedures. Dermatologic plastic surgery, i.e., hair transplantation, dermabrasion, soft tissue augmentation, chemical peel, blepharoplasty, face lift, and liposuction, is going to be an area of great competition between many specialty groups because of economic gain by the practitioner coupled with demand
Correspondence
1059
by patients for these procedures. Dermatologic surgery deserves the support of dermatology in general as much as the other special interest groups in dermatology, i.e., immunodermatopathology, dermatopharmacology, and pediatric dermatology. It should be noted that the American Society for Dermatologic Surgery has a membership of 1,500 and has doubled its membership in the past 3 years. This fact alone indicates the interest and involvement of dermatologists in dermatologic surgery. This is a time in the history of dermatology when we should be united to serve and to survive. My plea is not to overemphasize any phase of dermatologic training, but to train the individuals in all traditional areas of dermatology, including dermatologic surgery, which is now being recognized by training programs. Possessing the unique ability to diagnose skin disease properly (clinically and dennatopathologically), a thorough knowledge of the biology and pathophysiology of the skin, and multiple treatment modalities will place the dermatologist in a superior position to treat skin disease surgically.
Fred F. Castrow II, M.D., President American Society for Dermatologic Surgery 1567 Maple Ave., Evanston, IL 60201
Reply To the Editor: We would like to comment on Dr. Dobson's editorial from the vantage point of dermatologists who practice and teach both medical and surgical dermatology. Dr. Dobson has suggested that we intensify our training in traditional areas of dermatology, i.e., the recognition and treatment of diseases of the hair, skin, and nails. Dr. Dobson is, of course, correct, and he will undoubtedly continue to provide dermatologists with updated information in these areas through his highly successful postgraduate courses. With increasing competition from other specialties, however, the office dermatologist can no longer afford to send relatively straightforward excisional surgical procedures to other specialists. One of us (C. W. H.) recently attended a family medicine postgraduate course in which emphasis was placed on improving basic office surgical skills. Numerous cases were presented, including shave excision of pigmented nevi, scissors excision of skin tags, nail surgery, curettage-electrodesiccation of basal cell carcinoma, liquid nitrogen cryosurgery, simple excision of superficial malignant melanoma, and excision and skin grafting of deep malignant melanoma. In our opinion, every dermatologist who is capable
Steven L. Greene, M.D., Dermatology Department Group Health Cooperative of Puget Sound Olive Way Medical Center 509 Olive Way Suite 555, Seattle, WA 98101
Dermatology in dermatologic surgery To the Editor: This letter is written to compliment Dr. Dobson on his editorial, "Medicine and the Marketplace," in the June 1985 issue of the JOURNAL. He has attempted to address the new area of interest for all practitioners of dermatology, marketing. Advertising has always been a degrading word for the physician, and it has been replaced by the more palatable and encompassing word, marketing. The physician who survives in the future assault on fee-for-service medicine as traditionally practiced will be the one who has finely tuned his practice to incorporate new self-marketing technics, i.e., excellence in medical care, patient enhancements, patient surveys, focus groups, recalls, patient referral recognition, establishing patient corridors, and establishing market presence. The last phase of self-marketing would be direct advertising of the individual to the public. If advertising directly to the public is to be undertaken, then I believe it should be done for the corporate body of dermatology and not for an individual. This aspect of the future practice of dermatology in its relationship to the marketplace was not addressed. Self-marketing should be a high priority item for the American Academy of Dermatology's use of the funds generated by the recent assessment for public relations. In the last paragraph of his editorial, Dr. Dobson is again verbalizing the atavistic thinking that dermatology is a subspecialty of medicine and loosely associating dermatologic surgery with the more limited area of cosmetic surgery. Please do not confuse the core of dermatologic surgical skills with the more advanced dermatologic surgery procedures. Dermatologic plastic surgery, i.e., hair transplantation, dermabrasion, soft tissue augmentation, chemical peel, blepharoplasty, face lift, and liposuction, is going to be an area of great competition between many specialty groups because of economic gain by the practitioner coupled with demand
Correspondence
1059
by patients for these procedures. Dermatologic surgery deserves the support of dermatology in general as much as the other special interest groups in dermatology, i.e., immunodermatopathology, dermatopharmacology, and pediatric dermatology. It should be noted that the American Society for Dermatologic Surgery has a membership of 1,500 and has doubled its membership in the past 3 years. This fact alone indicates the interest and involvement of dermatologists in dermatologic surgery. This is a time in the history of dermatology when we should be united to serve and to survive. My plea is not to overemphasize any phase of dermatologic training, but to train the individuals in all traditional areas of dermatology, including dermatologic surgery, which is now being recognized by training programs. Possessing the unique ability to diagnose skin disease properly (clinically and dennatopathologically), a thorough knowledge of the biology and pathophysiology of the skin, and multiple treatment modalities will place the dermatologist in a superior position to treat skin disease surgically.
Fred F. Castrow II, M.D., President American Society for Dermatologic Surgery 1567 Maple Ave., Evanston, IL 60201
Reply To the Editor: We would like to comment on Dr. Dobson's editorial from the vantage point of dermatologists who practice and teach both medical and surgical dermatology. Dr. Dobson has suggested that we intensify our training in traditional areas of dermatology, i.e., the recognition and treatment of diseases of the hair, skin, and nails. Dr. Dobson is, of course, correct, and he will undoubtedly continue to provide dermatologists with updated information in these areas through his highly successful postgraduate courses. With increasing competition from other specialties, however, the office dermatologist can no longer afford to send relatively straightforward excisional surgical procedures to other specialists. One of us (C. W. H.) recently attended a family medicine postgraduate course in which emphasis was placed on improving basic office surgical skills. Numerous cases were presented, including shave excision of pigmented nevi, scissors excision of skin tags, nail surgery, curettage-electrodesiccation of basal cell carcinoma, liquid nitrogen cryosurgery, simple excision of superficial malignant melanoma, and excision and skin grafting of deep malignant melanoma. In our opinion, every dermatologist who is capable