PracticeUpdate: Dermatology & Rheumatology

2016 TOP STORIES IN DERMATOLOGY

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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.

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.

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.

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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DECEMBER 2016