A Conversation With Benjamin Kaffenberger, MD
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Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of The Dermatologist or HMP Global, their employees, and affiliates.
Q. What part of your work gives you the most pleasure?
A. I love the inquiry aspect. Every patient is a case of using the scientific method, and the opportunity to group patients together to further expand on trends and associations is extremely satisfying. Having young learners interested in what we do and willing to spend time, and even pay tuition, to learn from us is another aspect from which I derive immense fulfillment. Lastly, of course, are the patients. The opportunity to be trusted with their intimate details; to see and palpate the wounds, tracts, and sinuses they are most embarrassed about; and to give our patients their quality of life back is amazing. I think this aspect gets to the meaning of being a physician. Even in cases in which a severe illness is progressing and the patient is not getting better, we are providing comfort whether it be handholding, verbal support, or a willingness to try new things.
Q. Who was your hero/mentor and why?
A. Chief Justice John Roberts is someone I currently admire. Unrelated to his court decisions, I admire his ability to be steadfast in moderation. For someone who seems to be equally disliked by both the left and the right in the United States, I imagine it would be easy to vote in a manner that would garner consistent support from half of the country. Instead, I admire his willingness to vote in both directions and his attempts to maintain the integrity of the court in a raucous partisan time when moderation and compromise are often not celebrated.
Q. Which patient had the most effect on your work and why?
A. There are so many patients who have influenced me, it is difficult to choose just one. Most recently, I would mention a young woman with terrible pyoderma gangrenosum on her face. She had inconsistently followed up with dermatology 8 to 10 years previously but was mostly seen in the emergency department for repeated courses of pain medication and prednisone. All the while, the wound kept getting larger, taking over her face, ear, and scalp and approaching her eye. She would be admitted, we would see her in the hospital and prescribe immunosuppression and pain specialists would see her and prescribe opioids, but no outpatient physician would prescribe both for her and she did not have the means to go to multiple appointments a month. After seeing this cycle repeatedly, I finally agreed to be her out-patient prescriber of the opioids recommended by the inpatient pain teams. I saw her monthly for many years, during which she went through a lot of life changes, including multiple pregnancies. Unfortunately, as her wound was almost completely closed and I began to taper her opioids, she was admitted back to the hospital for overdosing on street fentanyl, brought on by an ad- diction to medications I was prescribing.
I imagine there are dermatologists who would say I had no business prescribing opioids to her in the first place, but I must believe that if I had not taken over her prescriptions in a way that made it feasible for her to treat both the inflammation and the pain of the disease, she likely would have lost her eye in addition to her ipsilateral ear. For the future, even though I do not want to prescribe these medications, I am still going to try to treat wound inflammation and pain together, and I am going to continue counseling my patients on the dangers of opioids. I do not know what the solution is, but I hope for my current and future patients that the easy, inexpensive access to heroin and now fentanyl derivatives changes soon.
