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The year’s top
research, all in
one issue
Welcome to our special issue,
PracticeUpdate
Dermatology &
Rheumatology: Best of 2016
–
bringing you a collection of the
best research of 2016 from the
world’s top rheumatology and
dermatology congresses. You’ll
find the best in here plus key
clinical commentary on why these
studies are practice-changing.
Our
PracticeUpdate Dermatology
advisory and editorial board
members share their views on their
pick of the top dermatology stories
of the year (see left & page 4).
On behalf of the Elsevier Australia
PracticeUpdate Dermatology
& Rheumatology
team, I thank
you for your continued support
and readership. We’ve had some
big changes this year with a new
name and improved content
which we hope helps you in your
clinical practice providing the best
patient outcomes.
I wish you well for 2017 –
and to the breakthroughs
next year will bring.
Happy summer reading!
Anne Neilson
Managing editor,
PracticeUpdate
Dermatology & Rheumatology
(Australian Edition)
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11, 28
Dr Eliot Mostow on shared
care to optimise outcomes
Eliot Mostow MD, MPH, is Professor and Head of the Dermatology Section at
Northeast Ohio Medical University in Ohio, and an Editorial Board Member of
PracticeUpdate Dermatology.
A
lthough difficult to pick one article that was a favourite, a study by Lui
and colleagues “Modeling the effect of shared care to optimise acne re-
ferrals from primary care clinicians to dermatologists” published this past
year in
JAMA Dermatology
rises to the top for me as top story of the year! (
JAMA
Dermatol
2016;152:655-660) A recent keynote lecture by Marty Makary at the
American Dermatological Association annual meeting (July 28–31, 2016, Boston,
Massachusetts) brought this into focus. Dr Makary is the co-developer of theWorld
Health Organization checklist outlined in Atul Gawande’s bestseller
The Checklist
Manifesto
(NewYork, NY. Metropolitan Books; 2009). He is a surgeon and professor
of public health at Johns Hopkins, and has written his own book,
Unaccountable:
What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health
Care
(Makary M. New York, NY. Bloomsbury Press; 2012). He believes that many
of the issues we face in medical care (eg, cost containment, efficient delivery of
care) can be addressed by acknowledging that the way we “always did it” might not
be the best approach from the standpoint of our patients and society as a whole.
Related to this, he advocates “accountability” in the form of data that show what
is being done and allowing one to compare the care provided by physicians and
institutions. His message is not specifically pro-government or pro-regulation. He
favours physicians identifying problems and working to improve systems that will
protect our patients. He suggests that physicians are generally competitive. Once the
data become transparent, we will work harder than ever to be the best we can be.
This message resonates when I think about this particular article and the com-
mentary that was written with my colleagues Drs Brodell and Bhatia. We can
address patient needs with respect to acne most effectively with a team approach.
Let’s start by working with our primary care colleagues (and patients) to promote
evidence-based medicine (eg, safe and effective use of topical retinoids in acne).
There is a plethora of data to support earlier use of topical retinoids because it
has been shown to improve outcomes in young patients with acne. So-called
“shared care” has the potential to optimise outcomes and minimise costs and
inconveniences for our patients.
Of course, it is not just about acne. There are many other conditions for which
access to board-certified dermatologists can be problematic! Earlier diagnosis of
skin cancers will surely help to reduce morbidity and mortality. In my opinion,
this will depend on everyone within the “house of medicine” keeping their eyes
open for potential melanomas and non-melanoma skin cancers. Other conditions
can also be attacked with better communication and education focused on the
improvement of outcomes.
This should not be perceived as “giving up” our turf in the realm of evidence-based
care of acne. On the contrary, it extends the reach of the dermatologist to serve
the needs of a population through data generated from studies in our literature.
Advanced disease will still be funnelled to specialists; but, at least at the popu-
lation level, perhaps much psychological and physical scarring may be addressed
sooner and avoided altogether with primary care physicians addressing the issue
and providing proven first-line therapies.
This article spoke to me as an example of one way to improve outcomes, reduce
costs, and ensure that dermatologists continue to contribute to the “house of
medicine.” This requires individual effort focusing on professionalism and ethics.
Let’s roll up our sleeves and work together to improve the dermatologic health
of our patients.
2016 TOP STORIES IN DERMATOLOGY
DECEMBER 2016
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