A good doctor always … has enthusiasm to find out what’s troubling the patient. A good doctor forms a partnership with the patient. They work together and try to find out what’s going on.
My typical patient: I see newborns, and my oldest patient is 106 years old, so anyone with any type of skin condition.
My biggest headache is … dealing with all the paperwork and insurance authorizations. I have several staff members that just deal with getting authorization for patients before I can even touch them. And you want to treat people, but a lot of insurance companies will say no. For example, some insurance companies consider acne cosmetic, but it’s not and they don’t cover any of the medicines that treat acne. They don’t cover a lot of medicines that treat pre-cancers.
The best advice I give is … to monitor for changing moles. Skin cancer for young women has tremendously increased in the last few years. I ask everyone in a family or couples to look at each other’s back … like, every three months. Women especially need to check their legs from the knee to the ankle because that’s where we’re seeing so many skin cancers. If color changes, if a mole is irritated or bleeding, definitely get in and see someone. It’s amazing how many people will see something then wait a couple of years to get it checked out.
The best advice I’ve gotten … was from my dean [at Wayne State University School of Medicine], who was also a family friend. He sat down with several of us and said, “Look back and see I’m helping you kids, and don’t forget that. Help other kids. Help their interests. Have them in your office or the hospital to help see what it’s like to give.”
My most memorable patient: We see thousands of psoriasis patients, and we had this young dad in his 30s, and he had to walk with two canes. One day his two little girls were like, “Tag, you’re it,” and ran, and said, “Come chase us, Daddy,” and he couldn’t. He was in tears. So I put him on one medicine that was experimental at the time, but now it’s available. Then I was taking my kids to bowl at Red Rock [Resort], and I felt someone slap my back. I looked around, and it was the young man. He was bowling and playing with his kids.
One thing people don’t know about my specialty is … that it doesn’t just involve the skin; that a lot of skin conditions are associated with internal problems. Certain skin conditions we can see would be associated with colon cancer; skin conditions we can see tell us there is something wrong with the liver. Dermatology is a subspecialty of internal medicine. A lot of times we identify what’s going on inside the body by what’s happening with the skin.
Avoid seeing me by … staying out of the tanning booth. There was a big study done a few years ago that showed that women 30 years old and under who spent continuous time in the tanning booth had an over-50 percent chance of developing melanoma. That’s really bad. So many young kids feel that being dark or tanning is a good thing, and really we’re seeing a lot more kids, like 13 or 14 years old. All it takes is a burn or two. Melanoma can kill you, and it’s not a good death.
The biggest difference with Obamacare … is young people being able to continue on their parent’s insurance until they’re 25. A lot of young people thought that by the time they turned 21 they would be off the insurance. It’s a good thing.
What the health-care industry needs most is … to focus more on preventative measures. In my field, most insurance doesn’t cover skin exams for moles. It’s considered cosmetic. That’s where it needs to change. If you can head something off, the cost [savings] is phenomenal down the line.
In 10 years, health care … I think there’s going to have to be a lot of streamlining of the paperwork and the authorization process with insurance, because a lot of doctors are leaving medicine or are being forced to see a lot more patients just to keep the door open. When I hear about some doctors having to double the number of patients but their reimbursement goes down 50 percent, there’s no way you can stay in business.
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