Congratulations to Jared Knickelbein, MD, PhD, whose photo, “Mount Hood Reflection,” was the first-place winner of the 2019 ACMS Bulletin Photo Contest. His photo will appear on the January 2020 cover of the Bulletin.

Additional winners include: Frederick B. Doerfler Jr., MD – “PPG City Reflections;” Elias Hilal, MD – “Kennywood Splash;” Leo Bastiaens, MD – “Monet;” Thaddeus Osial, MD – “White Pocket, AZ;” Alexanndra Kreps, MD – “Sunset over Cranberry Township;” Mark E. Thompson, MD – “Jelly Fish, Atlanta Aquarium;” Andrew W. Eller, MD – “Bridges on Mon;” Alan Klein, MD – “Sunset over Canon Beach;” Terence W. Starz, MD – “Land of the Free;” Kimberly Hennon, MD – “Wildflowers;” and Marc Garfinkel, MD – “Light at the End of the Tunnel.”

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These photos also will appear on 2020 Bulletin covers.

“There is a tide in the affairs of men.
 Which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and miseries.
On such a full sea are wow afloat,
And we must take the current when it serves,
Or lose our ventures.”

– Shakespeare, W. Julius Caesar, Act 4, Scene 3, 218-224

Shakespeare was a keen judge of human nature and as such knew that opportunity to accomplish a goal may only come once in a lifetime. For me, that opportunity for a career change came in 1982 as the result of a chance meeting.

“Send me a note on MyChart” were the last words my doctor uttered as she exited the exam room. I complied with her request 24 hours later and received a prompt and pertinent response. In contrast, six months earlier, I queried a different specialist through MyChart. It wasn’t urgent, but nevertheless, I failed to get a response. The note had been opened. I had a visit six weeks later with another physician in the same group. I asked my question and correspondingly commented on the lack of response to my electronic query. This second physician gently chided me: “Let me tell you how the sausage is made.

Dr. Neal Bernard recently wrote a JAMA Perspective that “Ignorance of Nutrition is No Longer Defensible.”¹ He recounts clinical scenarios in which physicians failed to (accurately) convey dietary advice to patients, concluding with five action steps: nutrition-related continuing medical education, partnering with registered dieticians, EMR resources, convincing physicians to change the way they eat and systemic improvements in food availability. With the amount of commercial and public health messaging about healthy habits, it boggles the mind to think anyone, let alone a physician whose professional organization asks him to categorize the mere presence of large body size as a disease,² could fail to have absorbed knowledge about nutrition.

Personalized, or precision, medicine promises a new paradigm of medical treatment, focused on individualized methods of disease diagnostics and treatment. Despite ongoing confusion about the meaning and interchangeability of both terms, personalized medicine broadly refers to “the tailoring of medical treatment to the individual characteristics of each patient,”1 while precision medicine broadly refers to the use of “omics” technology – emerging and ever-more complex genomic and proteomic tools – to identify markers that will subdivide patients into subgroups of expected response rates and facilitate individually targeted treatments.2 Implicit in these new terms is the idea of moving away from prior forms of medical practice: The terms alone insinuate that previously practiced medicine was impersonal and imprecise.

It’s hard to share my perspective without a little bit of background information. Twenty years ago, I completed my dermatologic cosmetic surgery fellowship and worked with UPMC to open an academically based cosmetic surgery center. Over the ensuing 20 years, I have trained numerous residents of various backgrounds (dermatology, plastic surgery, ear, nose and throat, ophthalmology) and have had eight formal fellows. I have lived through the evolution and growth in this field. 

Yes, I have seen the worldwide interest rise for neuromodulators (Botox, Dysport, etc.), fillers (Restylane, Juvederm, etc.) and body contouring surgeries to say the least. However, the biggest change has been in the arena of light-based technologies, including a plethora of lasers, radiofrequency and ultrasound devices meant to tackle just about any problem.