Open Journal Systems

LETTERS TO THE EDITOR

Underestimation of dermatology and the efforts of dermatologists to benefit patients

Adán Fuentes-Suárez,^a Luciano Domínguez-Soto^a

^aServicio de Dermatología, Hospital General “Dr. Manuel Gea González”, Secretaría de Salud, Distrito Federal, México

Communication with: Luciano Domínguez-Soto

Email: dermagea@gmail.com

Dr. Manuel Ramiro Hernandez, we are writing to you in response to letters that the doctors Asisclo Jesus Villagomez and Ricardo Juarez Ocaña sent you on the occasion of the publication of our article "The contempt of dermatology based on ignorance and its impact on patient health."

• The colleagues refute the text on some level on the basis that:
• The article should have been published more like a letter to the editor or opinion piece, not as done.
• It is unimaginable that all patients that have some type of skin condition could be seen by a dermatologist.
• Most dermatologists are engaged in cosmetic aspects and this is why they have little interdisciplinary participation.
• The article expresses only the personal views of the authors and is not based on academic references.

We can answer each of those claims as follows:

Our first request was that it be published as the colleagues propose. If the editorial board decided to publish our text as an article it is because they found a lot of truth in our arguments. We ended up greatly benefiting from this decision; approximately three months ago we received an invitation from a German publisher to publish a paper in English (with a minimum length of 42 pages, including clinical pictures) with exactly the same title as our article published in the Medical Journal of IMSS. This invitation was accepted of course and we are already working on it, which makes us think that the same undervaluing (due to ignorance) of dermatology is not unique to Mexico.

Our article does not intended to suggest that all patients be seen by a dermatologist, but rather that we be consulted when in doubt, and that prescriptions not be made without having the slightest idea of ​​the diagnosis. In that, you will surely agree with us, as it increases the risk of iatrogenesis and reflects unethical practice. And if that can be criticized privately, it can be criticized much more at the institutional level, where a doctor with doubts should seek consultation at the right time.

Precisely, our text critiques that doctors have no doubts, and they don’t have them because of almost total ignorance of the specialty. It is not bad to lack knowledge, but what is not justifiable is "not knowing that one does not know".

Like Dr. Jesus Villagomez, we observe with deep concern the unfortunate nature of cosmetology’s invasion of dermatology; in almost all dermatological congresses, if you want to have good attendance, a good number of discussions about these issues must be included. Regrettably, this is the trend not only in our country but throughout the world, as cosmetology or "cosmiatry" makes huge profits and only requires crafting more or less well done. It's a shame that after 4-6 years of training in dermatology many colleagues devote themselves to these activities exclusively.

If Dr. Asisclo identifies most dermatologists as dedicated to aesthetics, which can allow him to easily recognize the minority who continue exercising medical dermatology and seek out their interdisciplinary support.

As for us, we have been occupied with making sure that authentic courses are organized in the Dermatology Department of Hospital “Manuel Gea González”, as well as seminars and strictly scientific meetings related to Dermatology, obviously and unfortunately with very low attendance, but that has been our aim since nearly 40 years ago and we are not about to give up. These academic meetings (targeting almost all specialties, general practitioners, and students) are, of course, of the highest quality and are taught both in the capital and in some states of the Republic.

However, although the attendees, and in particular we refer to general practitioners, family or specialists from other areas, leave these meetings satisfied, the problem remains and, unfortunately, will persist; diagnosing a patient with skin problems requires "knowing how to see”, and thus we fall into an almost unsolvable problem, for that requires devoting a few days or weeks observing a lot of patients with diseases of various kinds.

Therefore, we definitely agree with the colleagues who wrote the corresponding texts, but they should also agree with us in that the right thing to do would be for all health practitioners to add one or two months of Dermatology service to their training rotation so that they could see the basics and realize that this discipline is not just about acne, blemishes, warts or fungus.

Of course there is no literature on the subject, and our article could be the start of said literature.

The references that we cited were to put in context the fact that practicing dermatology implies acquiring knowledge and skills as in any other specialty. The monograph that we are forming is based on everyday experience, both in private and institutional practices, and you would be amazed by the countless number of inadequately managed dermatological patients whose referrals are delayed or who come on their own.

In conclusion, it would be ideal if mere curiosity and a desire to know the basics, which are the most common skin diseases, were enough stop the iatrogenesis that we deal with day after day, and could that way put an end to prescription without diagnosis.

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