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Dr. Elpern grew up watching a previous generation of doctors at work.
Rather than complain, the dermatologist - who practices in Williamstown, Mass., a town of about 6,000 in the northwest part of the state - decided to do something about it. In 2002, he co-founded The Alliance for Humane Dermatology (AHD), which publishes Dermanities ( http://www.dermanities.com/), an online journal dedicated to covering the humanities and social sciences as they apply to the practice of medicine. The quarterly, founded in 2003, is now in its third year.
A different sort of journal The turning point for Dr. Elpern, who earned a literature degree from Columbia University, New York, occurred while he was a section editor at the Archives of Dermatology. Dermatology resident Benjamin Barankin, M.D., had submitted a piece related to the humanities of medicine. Dr. Elpern wanted to publish it in the journal, but the editorial board ultimately rejected it.
Fueled desire Research on the topic only fueled their desire. After conducting research in 2002, Dr. Elpern found that of the 81 dermatology journals, according to Medline, all covered the same type of thing: skin science, clinical disease, and techniques and procedures. Little space was available for the humane aspects of dermatology, such as literature, art, poetry and the social sciences.
Dr. Elpern picked the rather obscure dermatologic disease pemphigus and compared the citations for that in three major dermatologic journals (Archives of Dermatology, British Journal of Dermatology and Journal of the American Academy of Dermatology) with citations for patient-physician relations and medical philosophy.
"Out of about 30,000 articles, there were only 22 that talked about the doctor-patient relationship, and only eight spoke about the philosophy of medicine," Dr. Elpern says. "At the same time, there were about 700 articles on pemphigus. Two-point-three percent of all the articles in those journals were about pemphigus, and 0.1 percent of the articles had to do with the humane aspects of medicine. That is why we began Dermanities."
On its way Among the papers in the March 2003 inaugural issue was one by a medical student who talked about how seriously acne had impacted her as a person. A dermatologist and patient then offered their thoughts on the narrative.
"We have dermatology nurses, dermatologists, nondermatologist physicians and patients ... so really the entire healthcare team, including patients, has been involved in writing articles and being part of our editorial board. To have that breadth in medical publishing is unheard-of," Dr. Barankin says.
Through AHD, Dr. Elpern helps to coordinate professional meetings (one such all-day workshop was at the 63rd Annual Meeting of the American Academy of Dermatology in February).
"We get together as a community of people who want to share with each other aspects of dermatology or medicine that are not strictly knowledge-based or technical," Dr. Elpern says. "There is a French saying: 'To cure sometimes; to relieve often; to comfort always - this is our work.' Part of our job is to cure the occasional patient ... and we can relieve disease more often, but there are some people you cannot cure or relieve. It is then that you have to comfort, and that is something that I do not think the journals or residency programs or academies touch on much."