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.
Misha Rosenbach, MD, is an associate professor of dermatology and internal medicine at the Perelman School of Medicine at the University of Pennsylvania. He is the director of the inpatient consult service, and serves in a variety of educational roles including associate program director of the dermatology residency, and core clinical faculty in the department of medicine.
Dr Rosenbach’s clinical practice is focused on complex medical dermatology, where he runs a sarcoidosis clinic, urgent access clinic, and sees inpatients and outpatients with hematologic malignancies and cutaneous complications, autoimmune skin conditions, or patients with undiagnosed diseases. His research is focused primarily on sarcoidosis and granulomatous skin conditions.
He has published more than 100 peer-reviewed articles, multiple chapters, and textbooks. He has held leadership roles in the Medical Dermatology Society and Society of Dermatology Hospitalists, and is involved in the American Academy of Dermatology (AAD).
Q. What part of your work gives you the most pleasure?
A. I really enjoy collaborative care of complex patients with other physicians and trainees. In dermatology, we are lucky to be the experts in a field that is very visible to other doctors (and patients), but which other physicians often know relatively little about. When we as dermatologists engage in multidisciplinary care we can often bring a unique perspective and helpful diagnostic insights into complicated patients, and help unravel previously unrecognized illnesses or identify critical skin signs of systemic disease.
Q. Are an understanding and appreciation of the humanities important in dermatology and why?
A. The more widely learned and well-read one is, and the more world experiences one has in general, all help build a well-rounded physician, one who is better able to connect with a broad array of diverse patients from all socioeconomic and educational backgrounds. For patients to get better, they have to have rapport with their physicians, and trust that their doctors care not just about their disease, but about them as individuals—and an understanding of the humanities can help flesh out that doctor-patient bond.
Q. Who was your hero/mentor and why?
A. I have been fortunate to have a lot of very influential mentors who have helped shape my career; one of the benefits of being at a large academic institution, and of working within the AAD, is that you can connect with successful, inspiring people at different levels, and draw from their strengths to help build up yourself. Bill James comes to mind first, as an incredibly kind, caring, compassionate, and patient person, who always looks for—and brings out—the best in those around him. His door is always open, and no matter how busy he is, he can always find time to help. Jeff Callen is another. He is a brilliant medical dermatologist and diagnostician who seems like he can handle just about any patient or diagnosis, but also helps identify opportunities for his mentees and makes sure to put them in the spotlight to let their careers flourish. Ellen Kim, Joel Gelfand, John Stanley, Carmela Vittorio, George Cotsarelis, Vicky Werth, Lindy Fox, and I’m sure I’m leaving others out… I think it would not be fair to pick just one mentor—but I think that’s the key, really, to success and growth, is continuing to identify new mentor-mentee relationships and look for opportunities to grow and improve.
Article continues on page 2
Q. Which patient had the most effect on your work and why?
A. I feel so fortunate to practice inpatient dermatology and complex medical dermatology, where there are so many patients for whom we can have a profound impact. I still get holiday cards from someone who we diagnosed with Sweet syndrome during their treatment for leukemia 5 years ago, and get cookies on my birthday from this wonderful lady who had devastating pyoderma gangrenosum.
Overall, I will always remember my first patient with severe sarcoidosis with lupus pernio. She had disfiguring facial disease, and we tried just about every treatment before adalimumab [Humira] was approved for off-label use by her insurance company. She was the first patient with sarcoidosis that I treated with a biologic, and after her first injection she called me crying on the phone and said she had to come in. I was terrified that she had had a bad reaction; when she walked in, her face was already nearly clear. She had been crying because of how quickly and how well the medication had worked, and wanted to show me how well she was doing. That really showed me how important it is to fight for your patients and work to get the medications they need approved, and to work on clinical trials and try to build scientific evidence supporting appropriate treatments.
Q. What is the best piece of advice you have received and from whom?
A. I will paraphrase a story that Bill James tells the residents, but it boils down to: no matter how busy you are, and no matter how minor the ailment of the patient in front of you appears, remember that they came to you for help with their problem, and even if the prior patient was far sicker and the next one sicker still, the patient in front of you is here for your help, and it is your job to pay attention to them, to care about them as a whole, and to try to fix their problem. Bill also had lots of other good advice—like not to say anything that you would not want to appear in the paper the next day.
Q. Which medical figure in history would you want to have a drink with and why?
A. This is a great question! I honestly had not thought about this. The first answer that came to mind was James Lind—he did the first randomized trial (seawater and a few other treatment arms vs citrus fruits), although the results did not have the immediate impact they should have (everyone should read about scurvy, it is a fascinating history, and there are a few great books). A better answer may be Andrew Wakefield, and try to convince him not to falsely implicate vaccines and autism in his later-discredited work; vaccines are incredibly important, and it is a shame that now there’s some fear and doubt about their benefits.
Q. What is the greatest political danger in the field of dermatology?
A. My answer to this may have been very different a few months ago. The rapid changes and uncertainty in health care in the United States is obviously a huge concern, and I worry that it is too easy to look at doctors as part of the problem of rising costs, rather than as the best solution. The soaring cost of medications, with re-branding of generics and price gouging, along with the rise of intermediary pharmacy benefit management programs, are a huge problem—and consume far more health care costs than doctors. However, after seeing the national discourse during the contentious US election, I truly worry about what “post-truth” means for medicine. Watching the “debate” between climate scientists and those who deny what evidence-based studies demonstrate makes me worried for them, for science, and for our planet, but also for when and how that discourse will affect medicine, patients, and the doctor-patient relationship.
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.
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.
Misha Rosenbach, MD, is an associate professor of dermatology and internal medicine at the Perelman School of Medicine at the University of Pennsylvania. He is the director of the inpatient consult service, and serves in a variety of educational roles including associate program director of the dermatology residency, and core clinical faculty in the department of medicine.
Dr Rosenbach’s clinical practice is focused on complex medical dermatology, where he runs a sarcoidosis clinic, urgent access clinic, and sees inpatients and outpatients with hematologic malignancies and cutaneous complications, autoimmune skin conditions, or patients with undiagnosed diseases. His research is focused primarily on sarcoidosis and granulomatous skin conditions.
He has published more than 100 peer-reviewed articles, multiple chapters, and textbooks. He has held leadership roles in the Medical Dermatology Society and Society of Dermatology Hospitalists, and is involved in the American Academy of Dermatology (AAD).
Q. What part of your work gives you the most pleasure?
A. I really enjoy collaborative care of complex patients with other physicians and trainees. In dermatology, we are lucky to be the experts in a field that is very visible to other doctors (and patients), but which other physicians often know relatively little about. When we as dermatologists engage in multidisciplinary care we can often bring a unique perspective and helpful diagnostic insights into complicated patients, and help unravel previously unrecognized illnesses or identify critical skin signs of systemic disease.
Q. Are an understanding and appreciation of the humanities important in dermatology and why?
A. The more widely learned and well-read one is, and the more world experiences one has in general, all help build a well-rounded physician, one who is better able to connect with a broad array of diverse patients from all socioeconomic and educational backgrounds. For patients to get better, they have to have rapport with their physicians, and trust that their doctors care not just about their disease, but about them as individuals—and an understanding of the humanities can help flesh out that doctor-patient bond.
Q. Who was your hero/mentor and why?
A. I have been fortunate to have a lot of very influential mentors who have helped shape my career; one of the benefits of being at a large academic institution, and of working within the AAD, is that you can connect with successful, inspiring people at different levels, and draw from their strengths to help build up yourself. Bill James comes to mind first, as an incredibly kind, caring, compassionate, and patient person, who always looks for—and brings out—the best in those around him. His door is always open, and no matter how busy he is, he can always find time to help. Jeff Callen is another. He is a brilliant medical dermatologist and diagnostician who seems like he can handle just about any patient or diagnosis, but also helps identify opportunities for his mentees and makes sure to put them in the spotlight to let their careers flourish. Ellen Kim, Joel Gelfand, John Stanley, Carmela Vittorio, George Cotsarelis, Vicky Werth, Lindy Fox, and I’m sure I’m leaving others out… I think it would not be fair to pick just one mentor—but I think that’s the key, really, to success and growth, is continuing to identify new mentor-mentee relationships and look for opportunities to grow and improve.
Article continues on page 2
Q. Which patient had the most effect on your work and why?
A. I feel so fortunate to practice inpatient dermatology and complex medical dermatology, where there are so many patients for whom we can have a profound impact. I still get holiday cards from someone who we diagnosed with Sweet syndrome during their treatment for leukemia 5 years ago, and get cookies on my birthday from this wonderful lady who had devastating pyoderma gangrenosum.
Overall, I will always remember my first patient with severe sarcoidosis with lupus pernio. She had disfiguring facial disease, and we tried just about every treatment before adalimumab [Humira] was approved for off-label use by her insurance company. She was the first patient with sarcoidosis that I treated with a biologic, and after her first injection she called me crying on the phone and said she had to come in. I was terrified that she had had a bad reaction; when she walked in, her face was already nearly clear. She had been crying because of how quickly and how well the medication had worked, and wanted to show me how well she was doing. That really showed me how important it is to fight for your patients and work to get the medications they need approved, and to work on clinical trials and try to build scientific evidence supporting appropriate treatments.
Q. What is the best piece of advice you have received and from whom?
A. I will paraphrase a story that Bill James tells the residents, but it boils down to: no matter how busy you are, and no matter how minor the ailment of the patient in front of you appears, remember that they came to you for help with their problem, and even if the prior patient was far sicker and the next one sicker still, the patient in front of you is here for your help, and it is your job to pay attention to them, to care about them as a whole, and to try to fix their problem. Bill also had lots of other good advice—like not to say anything that you would not want to appear in the paper the next day.
Q. Which medical figure in history would you want to have a drink with and why?
A. This is a great question! I honestly had not thought about this. The first answer that came to mind was James Lind—he did the first randomized trial (seawater and a few other treatment arms vs citrus fruits), although the results did not have the immediate impact they should have (everyone should read about scurvy, it is a fascinating history, and there are a few great books). A better answer may be Andrew Wakefield, and try to convince him not to falsely implicate vaccines and autism in his later-discredited work; vaccines are incredibly important, and it is a shame that now there’s some fear and doubt about their benefits.
Q. What is the greatest political danger in the field of dermatology?
A. My answer to this may have been very different a few months ago. The rapid changes and uncertainty in health care in the United States is obviously a huge concern, and I worry that it is too easy to look at doctors as part of the problem of rising costs, rather than as the best solution. The soaring cost of medications, with re-branding of generics and price gouging, along with the rise of intermediary pharmacy benefit management programs, are a huge problem—and consume far more health care costs than doctors. However, after seeing the national discourse during the contentious US election, I truly worry about what “post-truth” means for medicine. Watching the “debate” between climate scientists and those who deny what evidence-based studies demonstrate makes me worried for them, for science, and for our planet, but also for when and how that discourse will affect medicine, patients, and the doctor-patient relationship.
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.
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.
Misha Rosenbach, MD, is an associate professor of dermatology and internal medicine at the Perelman School of Medicine at the University of Pennsylvania. He is the director of the inpatient consult service, and serves in a variety of educational roles including associate program director of the dermatology residency, and core clinical faculty in the department of medicine.
Dr Rosenbach’s clinical practice is focused on complex medical dermatology, where he runs a sarcoidosis clinic, urgent access clinic, and sees inpatients and outpatients with hematologic malignancies and cutaneous complications, autoimmune skin conditions, or patients with undiagnosed diseases. His research is focused primarily on sarcoidosis and granulomatous skin conditions.
He has published more than 100 peer-reviewed articles, multiple chapters, and textbooks. He has held leadership roles in the Medical Dermatology Society and Society of Dermatology Hospitalists, and is involved in the American Academy of Dermatology (AAD).
Q. What part of your work gives you the most pleasure?
A. I really enjoy collaborative care of complex patients with other physicians and trainees. In dermatology, we are lucky to be the experts in a field that is very visible to other doctors (and patients), but which other physicians often know relatively little about. When we as dermatologists engage in multidisciplinary care we can often bring a unique perspective and helpful diagnostic insights into complicated patients, and help unravel previously unrecognized illnesses or identify critical skin signs of systemic disease.
Q. Are an understanding and appreciation of the humanities important in dermatology and why?
A. The more widely learned and well-read one is, and the more world experiences one has in general, all help build a well-rounded physician, one who is better able to connect with a broad array of diverse patients from all socioeconomic and educational backgrounds. For patients to get better, they have to have rapport with their physicians, and trust that their doctors care not just about their disease, but about them as individuals—and an understanding of the humanities can help flesh out that doctor-patient bond.
Q. Who was your hero/mentor and why?
A. I have been fortunate to have a lot of very influential mentors who have helped shape my career; one of the benefits of being at a large academic institution, and of working within the AAD, is that you can connect with successful, inspiring people at different levels, and draw from their strengths to help build up yourself. Bill James comes to mind first, as an incredibly kind, caring, compassionate, and patient person, who always looks for—and brings out—the best in those around him. His door is always open, and no matter how busy he is, he can always find time to help. Jeff Callen is another. He is a brilliant medical dermatologist and diagnostician who seems like he can handle just about any patient or diagnosis, but also helps identify opportunities for his mentees and makes sure to put them in the spotlight to let their careers flourish. Ellen Kim, Joel Gelfand, John Stanley, Carmela Vittorio, George Cotsarelis, Vicky Werth, Lindy Fox, and I’m sure I’m leaving others out… I think it would not be fair to pick just one mentor—but I think that’s the key, really, to success and growth, is continuing to identify new mentor-mentee relationships and look for opportunities to grow and improve.
Article continues on page 2
Q. Which patient had the most effect on your work and why?
A. I feel so fortunate to practice inpatient dermatology and complex medical dermatology, where there are so many patients for whom we can have a profound impact. I still get holiday cards from someone who we diagnosed with Sweet syndrome during their treatment for leukemia 5 years ago, and get cookies on my birthday from this wonderful lady who had devastating pyoderma gangrenosum.
Overall, I will always remember my first patient with severe sarcoidosis with lupus pernio. She had disfiguring facial disease, and we tried just about every treatment before adalimumab [Humira] was approved for off-label use by her insurance company. She was the first patient with sarcoidosis that I treated with a biologic, and after her first injection she called me crying on the phone and said she had to come in. I was terrified that she had had a bad reaction; when she walked in, her face was already nearly clear. She had been crying because of how quickly and how well the medication had worked, and wanted to show me how well she was doing. That really showed me how important it is to fight for your patients and work to get the medications they need approved, and to work on clinical trials and try to build scientific evidence supporting appropriate treatments.
Q. What is the best piece of advice you have received and from whom?
A. I will paraphrase a story that Bill James tells the residents, but it boils down to: no matter how busy you are, and no matter how minor the ailment of the patient in front of you appears, remember that they came to you for help with their problem, and even if the prior patient was far sicker and the next one sicker still, the patient in front of you is here for your help, and it is your job to pay attention to them, to care about them as a whole, and to try to fix their problem. Bill also had lots of other good advice—like not to say anything that you would not want to appear in the paper the next day.
Q. Which medical figure in history would you want to have a drink with and why?
A. This is a great question! I honestly had not thought about this. The first answer that came to mind was James Lind—he did the first randomized trial (seawater and a few other treatment arms vs citrus fruits), although the results did not have the immediate impact they should have (everyone should read about scurvy, it is a fascinating history, and there are a few great books). A better answer may be Andrew Wakefield, and try to convince him not to falsely implicate vaccines and autism in his later-discredited work; vaccines are incredibly important, and it is a shame that now there’s some fear and doubt about their benefits.
Q. What is the greatest political danger in the field of dermatology?
A. My answer to this may have been very different a few months ago. The rapid changes and uncertainty in health care in the United States is obviously a huge concern, and I worry that it is too easy to look at doctors as part of the problem of rising costs, rather than as the best solution. The soaring cost of medications, with re-branding of generics and price gouging, along with the rise of intermediary pharmacy benefit management programs, are a huge problem—and consume far more health care costs than doctors. However, after seeing the national discourse during the contentious US election, I truly worry about what “post-truth” means for medicine. Watching the “debate” between climate scientists and those who deny what evidence-based studies demonstrate makes me worried for them, for science, and for our planet, but also for when and how that discourse will affect medicine, patients, and the doctor-patient relationship.
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.
