New DermTales captures hearts through storytelling

Today’s culture has a new appreciation for what was once called “the lost art of storytelling.” On Friday, four dermatologists celebrated and added to this tradition, sharing some of the best stories and lessons learned from their careers during the new Plenary (P151) addition, “DermTales.” Each of the featured storytellers — or “slammers” — had 5 minutes to share an experience that affected how they practice dermatology.

The AAD solicited story submissions from AAD members. The selected storytelling team included Boynton Beach, Florida dermatologist Andrew Hart Weinstein, MD, MPH; Charles N. Ellis, MD, University of Michigan Medical School; Robert T. Brodell, MD, University of Mississippi Medical Center; and Steven T. Chen, MD, MPH, Massachusetts General Hospital. David M. Ozog, MD, Henry Ford Hospital in Detroit, served as the director of this exciting, new presentation, which debuted at the 2019 AAD Summer Meeting.

Never give up!

Steven T. Chen, MD, MPH.

Dr. Chen recounted a heartbreaking story of a patient who came so close to giving up on a successful treatment for his skin condition, he considered taking his own life. The patient began seeing Dr. Chen after being told by his previous dermatologist that nothing could be done to treat an intractable itch.

“After a lot of trial and error, we were able to find a combination of things that finally gave him some relief. At one of his follow-up appointments, he said, ‘Thank you for saving my life.’ He had been thinking of committing suicide because of the itch. Our partnership and his gradual improvement convinced him to reconsider,” Dr. Chen said. “Always trust your instincts (he told me he was doing fine, but he had a bloody shirt from scratching so much, and he cancelled a few times, isolating himself more) and never give up. There were times that I thought I might not be able to help him, but it was just the mere act of trying something new and continuing to work with him that helped convince him to keep plugging away.

“It was such a profound and formative experience. It reminded me that even if something is relatively straightforward (in terms of treatment ladder, next steps), it may be life-changing and altering for the patient,” he said. “In thinking about our physician wellness, it really looks different for everyone. This experience really recharged me.”

As for the implication of his story, Dr. Chen said it underscores the need for dermatologists to take their time treating patients, even when running late for an appointment. It’s also a great reminder of not giving up on a patient’s disease.

“Even when it seems hopeless and nothing seems to be working, just meeting with our patients and discussing options and the next line of therapy may be all they need to feel cared for,” Dr. Chen said. “Of course, I will always remember to ask for help when needed, but when we’ve exhausted that option or are functioning alone, these lessons help me keep going for my patients.”

Knowing when to whistle

Charles N. Ellis, MD.

Dr. Ellis introduced his personal tale with an introspective take on the well-known Disney tune, “Whistle While You Work.”

“It purports to make your work feel easier to accomplish. But what about whistling after your day at work ends or, better yet, on your way into work?”

Dr. Ellis said most doctors have experienced the exultant whistling of accomplishment.

“One of my examples is when I prevented a patient’s scheduled below-the-knee amputation because of a chronic leg ulcer,” he said. He stalled the surgery, believing there was a better treatment method for the leg ulcer. He was right. “The ulcer healed, and the patient kept his leg. I whistled all the way home!”

The idea of whistling on the way to work started with another life-changing incident. When his medical school dean, tired of receiving complaints about quality service within the health system, pointed his finger at the department chairs and said, “Do something about this poor service,” the task ultimately fell on Dr. Ellis to improve service in his own department.

The hospital sent several department chairs to Walt Disney World to visit the Disney Institute, a health care-focused customer service training program. But Dr. Ellis found a less “animated” program with Ritz-Carlton hotels. Dr. Ellis and his staff returned with 35 Ritz-Carlton service strategies and put nine of them into practice.

“Those service techniques have placed our dermatology department at the top of patient satisfaction for over 20 years,” he said. “Today, all our doctors and staff say ‘My pleasure’ in response to any request, and they appear truly pleased to help. If you say ‘My pleasure’ instead of ‘You’re welcome’ dozens of times a day, it becomes internalized and you remember it is a pleasure to take care of patients. After all, helping people is why we went into medicine.”

During this time, Dr. Ellis taught the pearls he has learned and coached over 200 new dermatologists who have changed the practice of dermatology and taken the program to other teaching institutions and private offices.

And there was another, unexpected benefit.

“Everyone in the department started helping each other more, saying ‘It would be my pleasure to help you with this.’ Everyone’s satisfaction increased, patients and employees alike. The number of compliments from patients shot through the roof. Our employee satisfaction scores jumped way up. And I often heard doctors and staff humming or whistling on their way into our offices. We had changed our culture and changed our work lives for the better.”

The power of stories

Robert T. Brodell, MD.

Dr. Brodell understood the value of storytelling when he attended the 2017 AADA Legislative Conference in Washington, D.C. It was there that a presenter stated that “a good story is often more important than science!”

Hard to believe, but worth checking out, Dr. Brodell believed. He asked his son, DW Brodell, MD, a third-year dermatology resident at the University of Rochester School of Medicine and Dentistry to investigate the science of storytelling. Together, the father-son duo published “Storytelling in Dermatology” in Skin: The Journal of Cutaneous Medicine.

“The word ‘doctor’ comes from a Latin word meaning ‘teacher.’ Dermatologists spend their lives telling stories to their patients, and we’re pretty good at it,” Dr. Brodell said. “When I learned about the science of storytelling and the six components of a good story, it all made perfect sense to me that dermatologists should be putting some effort into perfecting the stories we use.”

Once, when one of Dr. Brodell’s patients was hesitant to try the acne medicine, isotretinoin, on her child, Dr. Brodell changed her mind by sharing his own personal story of using it on three of his five children.

“The work of a physician involves the presentation of scientific data at a level that can be understood by the patient and skillful storytelling,” he said. “Don’t neglect the power of a good story! Craft your stories carefully, practice them, and use them wisely.”

Best laid plans

Andrew Hart Weinstein, MD, MPH.

When Dr. Weinstein was getting his practice off the ground in 2005, he intended to be organized and to run his practice like “a well-oiled machine.” Despite all the oil, however, a machine can always go awry. And he learned that patients can teach you a thing or two about navigating the unexpected.

Dr. Weinstein shared a story of a mom and her small army of sons who visited his practice one day. Even before he met the family of Orthodox Jews, he rushed to judgment, predicting a tough case ahead once he saw that one of the children was “tiny and red.”

Dr. Weinstein’s observation was interrupted by one of the other boys, who was thrusting his finger forward, seeking treatment for a wart. After treating it, he returned his attention to the small, red boy and asked if he could do anything else. When the mom didn’t bite, Dr. Weinstein pressed on. He soon learned the boy — Mendel— had a serious and as-yet-undiagnosed condition.

“She rattled off the list of an eclectic group of specialists that they had met. It was a who’s who of department heads and book authors. They had visited some incredible centers of excellence, but had no answers about what to do with the boy, or even what he had.”

While the visit did not yield a diagnosis for Mendel’s condition, something powerful had occurred in the doctor and patient interaction.

“It turned out to be more about how much meaning and satisfaction patients can bring. That first meeting was the start of a close relationship between this family and me,” he said.

Mendel would eventually receive a diagnosis of Congenital Ichthyosiform Erythroderma (CIE), and in the ensuing years, Dr. Weinstein got to know the family. He learned they wanted to add a girl to their family. Unfortunately, CIE is autosomal recessive. Everyone in the family had been genotyped. Dr. Weinstein feared it would take a miracle to bring a girl into the family.

“I must tell you that I was moved to tears when I met the little girl at Mendel’s bar mitzvah years later,” he said. “In Yiddish, the term ‘bashert’ means destiny — something meant to be. I think it applies here. Mendel is a young adult now. I like to think I helped him to grow into a happy one. But that day, it was me who was being tested.”

Indeed, Mendel’s mom later admitted she orchestrated the wart visit as a ruse. She wanted to make sure that Dr. Weinstein was the right doctor for her son.

“I hope I’ve lived up to that standard,” he said. “If you haven’t yet found your Mendel, I encourage you to do so. I have been able to develop a very efficient office, but not so efficient that occasionally I don’t sit back down in my chair and wait for the unexpected to happen.”