Issues Confronting Dermatology in the 21st Century

BULLETIN FOR MEDICAL PRACTITIONERS
 

Professor Steven Katz, Director of the National Institute of Arthritis, Musculoskeletal and Skin Diseases, USA
Reported by Dr Melvin Ee, Registrar National Skin Centre

Professor Steven Katz, a world-renowned dermatologist and the current Director of the National Institute of Arthritis, Musculoskeletal and Skin Diseases, USA, was NSC's HMDP Visiting Expert for 2002. In his inaugural speech in Singapore at the NSCs Faculty Dinner held on 9 November 2002 at the Sheraton Towers Hotel, he spoke about the critical issues that dermatologists will face in the 21St century.

Recounting his own experiences as a junior doctor, he navigated the audience through the practice of clinical dermatology, from the advent of topical steroids in the 1960's, to the 21st century, where basic science, genomics and proteomics are but an integral part of dermatology.

The focus of his speech was on what dermatology should do to remain relevant today. There is an unfortunate trend that dermatology is increasingly being confined to an outpatient discipline and loosing its expertise in and influence on in-patient management of more complicated dermatological-medical conditions. There is a real and constant risk of dermatology being marginalized by other specialties and a pressing need to maintain core dermatological beds within the realms of medicine; for example, exemplary units in Munich, where there are 220 beds for dermatology, and in Milan, where a dedicated dermatology service for children exists.

It is lamentable that there is tremendous focus on appearance rather than illness in the USA today; and this over-emphasis on appearance will progressively put the specialty in greater danger of being trivialized. Asia is not far behind in adopting these policies seen in Western nations, and the importance of striking the right balance cannot be more forcibly emphasized.

To develop as a specialty over the next few years, dermatologists should:

1. Enlarge or maintain our clinical scope
2. Continue to attract the best and brightest and maintain dermatology as a sought after specialty
3. Seize the many scientific opportunities that are critical and integral to our specialty, especially where uncommon diseases are more prevalent in our parts of the world
4. Collaborate with industries, government and professional groups on issues that are important to patients with skin diseases and which further the understanding of skin biology
5. Maintain integrity as a specialty, and make clear distinctions between ethics and industrial interest
6. Organize and embrace the many and varied lay-man support groups that have an interest in dermatology and skin biology so that we can utilize them as a source for patient education and governmental feedback

Failure to meet the above challenges would result in fragmentation and marginalization of the specialty, which could end up being trivialized by the other specialties e.g. pathology, oncology, pediatrics and infectious diseases.

Dermatology would continue to enjoy its current prestige as long as we continue to be vigilant and diligent in retaining our investigative dermatological approach, as well as to maintain a strong basic scientific base so as to be able to excel both at the forefront of medical research and in clinical dermatology.

He concluded, "There are many opportunities in the dermatological sciences. The scope of dermatology as far as I am concerned is good in terms of where we are but we have to capitalize on them. I think the opportunities are great, I think the challenges are enormous, the dangers are real and in a very short time the specialty, at least in the USA, may go down the drain despite the fact that it has risen to a tremendous level in terms of its reputation and in terms of young people becoming dermatologists. I think that it is in constant danger; hence we have to be vigilant, diligent in maintaining the specialty. I think you have many opportunities here because you have not suffered many of the consequences that we have suffered. So you have many lessons that you can learn from us in not only what to do and most importantly what not to do.

DEDICATED TO EXCELLENCE IN DERMATOLOGY
By National Skin Centre (Singapore)
Copyright (C) 1995 - National Skin Centre (Singapore)

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