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Mastering the 'arts' of medicine and apperance


I recently had the opportunity to attend the European Academy of Dermatology and Venereology (EADV) in Florence, Italy. It was a long trip across the wide Atlantic and I received a speaking assignment at 2 a.m. EDT, which is not my best hour for optimal mental functioning and a smooth, flawless delivery.

Nevertheless, the meeting was fascinating, offering talks on areas of dermatology I had forgotten many years ago, as I no longer see these medical conditions in my office. It was a busy week, made more complex by the six-hour time change, yet I returned home inspired and refreshed.

Not only was the meeting a wonderful view of worldwide dermatology, I found myself spending every free moment in the marvelous museums of Florence. I had breakfast with Michelangelo's marble sculpture of David, I had lunch with a newly discovered painting of a female face by Leonardo da Vinci, and I had dinner with Rubens' cherubic children.

The next week I found myself back in High Point, N.C., seeing office patients. My first case was a basal cell carcinoma of the ear.

I examined the ear, planning how best to remove the tumor without destroying the shape of the tragus, when a flashback to the face of Michelangelo's David with his curls draping around a meticulously fashioned ear appeared in my mind. My next case was a liposuction of an aging female neck. The statuesque neck of Da Vinci's newly married woman appeared in my mind. My third case was a filler injection, and the round-cheeked children of Rubens were recalled. I realized that I was not that different than the violin carver or the cobbler. I, too, created shapes and images, but with living human flesh - an artist of sorts in my own right.

The following week I shared a lecture with a group of new dermatology residents on cosmetic dermatology. They were a lively bunch, full of excitement and questions. One young resident asked how to train to become a superb cosmetic dermatologist. Should he read up on all the new products to dispense in his office? I said, "No." Should he examine all of the new light devices on the market to determine which machine offered the best combination of reliability and versatility? I said, "No." Should he develop a relationship with an aesthetician to employ in his office? I said, "No." He was quite surprised.

After some thought, I recommended he spend as much time as possible visiting art museums and examining art books. I firmly believe that dermatology is the closest medical specialty to human art. It requires the ability to distinguish subtle differences in color and blend various skin tones. It requires an appreciation of symmetry, proportion and shape. It requires a three-dimensional eye that can spot texture changes indicative of a basal cell carcinoma. It requires a vision of beauty to transform a protuberant abdomen through liposuction. These skills cannot be learned in dermatology textbooks. No, an artistic sense must be cultivated through the appreciation of all forms of art.

The inspiration I derived from my EADV Florence experience was the perfect combination of dermatologic art. The art of making a dermatologist involves not only mastering the "art" of medicine, but also mastering the "art" of appearance. These "arts" must coexist within our specialty.

Zoe Diana Draelos, M.D. Clinical associate professor of dermatology, Wake Forest University School of Medicine, Winston-Salem, N.C.

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