The Room Where it Happens

If you like the musical Hamilton, that title says it all.

In the musical, based on Alexander Hamilton's life, we are raced through the different decades and relationships he had while rising to the top. One relationship, which essentially ended his life, was with Aaron Burr.

During a time when things were being discussed and re-written, Hamilton had an audience with two other very powerful and influential men. Burr, jealous that he was not invited to participate, felt left out, wishing he could be "in the room where it happens."

Sometimes, I feel the same when thinking of dermatologists.

How does this relate to eczema?

I recently inquired about an upcoming dermatology conference called the AAD - American Academy of Dermatology. This is like the mecca of meetings where all the members of the academy get together and learn from one another. From new research to lectures on treatments and diagnosis, it is all there.

But, rarely are patients allowed to be involved. I get it, we aren't board-certified dermatologists with years of medical background and education, but it would feel good to have representation at these events.

The reason I say this is because of that age, old expression - "locker room talk." When a group of dermatologists wielding a lot of authority don't have accountability in their midst, sometimes things aren't taken into consideration - like the group they are serving.

What happened the last time I was in the room?

I know my statements seem on the fringe of being skeptical towards doctors, but hear me out.

One time, back in 2018, I was given the chance to attend a conference much like the AAD, where dermatologists from around the world all gathered together in order to continue their education. I was thrilled. I relish geeking out on some studies and genuinely like hearing about new research in eczema.

Well, did I get an ear full at one lecture.

This particular dermatologist, standing in front of a packed banquet hall, began to disseminate how lots of patients just don't listen. I looked around the room to see if other doctors found this odd. No one seemed fazed. He then continued to state that patients basically don't know what they need and that if our eczema is bad, it is because we are mismanaging it. His answer: Lather them in steroids.

What else did the dermatologist say?

I was beyond mortified when he kept reiterating how much he knew as a dermatologist and what little patients knew simply because he wrote them off as exactly that - patients, people with no formal education. Internet warriors.

And when faced with patients who ask him if he is prescribing them a steroid, he blatantly stated that he outright lies to them. You could tell he rehearsed this next bit, not as a medical professional, but as a comedian awaiting his applause. He divulged that he would say something like... "this is an all-natural, organic, anti-inflammatory, designed to compliment your natural healing mechanisms to bring the system back into balance and harmony, because I like to take a holistic approach to the management of patients with skin disease."

VERBATIM.

What can we do as patients?

Now I don't share this to discredit all doctors or to sway patients to think that all doctors are callous, conceded, and pompous (though he certainly was), but to help patients understand that not all doctors are created equal. You have EVERY right to question the prescription they are writing for you, as well as the pros and cons of its use. You also deserve a doctor who does not look down on a holistic approach to healing as a laughable form of treatment. That is a scary frame of mind coming from someone who knows that science is ever-evolving and that no two patients are exactly the same.

So, do your research. Shop around different dermatologists if you have to, which I know is easier said than done. But don't ever allow a physician to bully you into something that does not feel right or is explained properly to you. And I hope that one day, those types of doctors who are smug and arrogant and only looking out for their praise no longer get to be in the room where it happens.