A Conversation With Girish (Gilly) Munavalli, MD, MHS, FACMS

Dr Munavalli is medical director and founder of Dermatology, Laser, & Vein Specialists of the Carolinas, with multiple locations in Charlotte, NC. He completed his residency in dermatology at Emory University in Atlanta, GA, and received his board certification in dermatology in 2002. Dr Munavalli pursued fellowship training in Mohs micrographic surgery, cosmetic and laser surgery at the University of California, San Francisco. In addition, he completed a phlebology and advanced laser surgery fellowship year at the MD Laser, Skin, and Vein Institute outside of Baltimore, MD.

Prior to his dermatology training, Dr Munavalli graduated with a Bachelor of Science from the University of North Carolina-Chapel Hill, completed a Masters in Immunology/Infectious Diseases from the Johns Hopkins University Bloomberg School of Public Health, obtained his Doctorate of Medicine from Morehouse Medical School in Atlanta, and transitional surgical internship training at the Mayo Clinic in Scottsdale, AZ. 

Dr Munavalli has spent 8 years as an assistant clinical professor at the Wake Forest University Department of Dermatology in Winston-Salem, NC, and serves as a co-director of a Charlotte-based ASDS fellowship program. He previously spent 3 years on the clinical faculty of dermatology at Johns Hopkins School of Medicine.

On a personal note, Dr Munavalli is a native of North Carolina, spending over one-third of his life in his home state. Outside of his practice, he enjoys reading, exploring, tropical fish keeping, sports, as well as spending free time with his family.

Q. What part of your work gives you the most pleasure?
A. I truly love my job. I derive deep satisfaction from helping people and, luckily for me, being a a dermatologic surgeon allows me to do this everyday. I also derive deep satisfaction from being presented with therapeutic challenges because they expand the bounds of my knowledge and present opportunities to learn and grow. When faced with a complex presentation, I take great joy in educating myself, diving deep into new bodies of scientific literature, and making creative connections to solve clinical challenges. Patients may come to see me by way of a trusted referral from a colleague, by reputation, by word of mouth, or via online research, but every workday presents the extraordinary opportunity to change someone’s life and leave them feeling better than they were when they came into our practice. 

Fortunately, in our office and geographic region, we get to see a very diverse patient population, often with unusual and very challenging concerns. My training has prepared me to offer our patients with diverse needs and skin types, a very broad range of medical and surgical interventions. Our diverse patient population and their wide clinical needs also requires me to stay constantly abreast on new ways to treat and think about how best to address patient concerns. I love to learn treatment approaches from the many talented colleagues in our field.

The ability to meet a patient’s expectations is a powerful responsibility and very much dependent on my skills as a physician, a communicator, and as an observer. There is an adage, “we are only as good as our last patient,” and I tend to live by that every day. Another aspect of my job that I love is taking an idea or thought inspired from a clinical patient observation and building it into a supportive concept and eventual publication, as evidenced by my recently published findings correlating dermal filler reactions with COVID-19 infection/vaccination. Publishing in order to contribute to our specialty’s base of knowledge, for all to utilize, is immensely satisfying.

Q. Who was your hero/mentor and why?
A. My parents are, without doubt, my heros. Growing up first generation in an immigrant household, I really didn’t adequately appreciate all the quiet sacrifices that my parents made in order to ensure that they provided us with every opportunity to succeed, professionally and personally. It was only in adulthood and when I became a parent myself that I became fully conscious of all the challenges they faced to give us the life and futures we have. My parents came to United States almost penniless, navigated an unfamiliar culture, raised a family, and forged a successful life through extreme hard work and a deep belief in the power of advanced education. Being surrounded by these values has deeply impacted my values, and who I am today.

Rummaging through some old family records 10 years ago, I learned that my parents were minutes away from being turned away at Ellis Island and sent back to India due to an anomalous screening chest x-ray of my father, which was suspicious for tuberculosis (at the height of the tuberculosis scare). A kind immigration officer took the time to look through all their health records (some in English and some not) and determine that some issues had been present for decades and may be the cause of his abnormal imaging. They were able to pass into a quarantine section, in which they resided for weeks until more formal records were obtained from overseas, which allowed them to formally gain entry in to the United States. For as long as I can remember, my parents have always embodied this same graciousness of spirit, kindness, and helpfulness–with our home always being open to anyone who needed a place to feel welcome or a hot meal. These values are among those I hold very dear as well.

Q. Which patient had the most effect on your work and why?
A. Back in the early 2000s, I had a patient who was extremely anxious. In the midst of a full body exam, I discovered both nonmelanoma skin cancer and melanoma in situ on his face and body. I worked with him extensively to allay his fears and surgically manage his issues. I noticed during our visits that he was fixated on numbers—the chance of recurrence, the likelihood that he would get another, and the timeframe in which these events might occur. He looked up many statistics and referenced National Comprehensive Cancer Network guidelines in our conversations. He was always very respectful and deferential, and he fit the true definition of a worry wart.

I tried to get him to not fixate so much on the numbers, but he said, “Doc, it is what I do. I’m a professional sports handicapper.” I love sports, so this fascinated me. He told me not to take his word for it but to listen on the weekends to his radio show, which I did. On the air, he was a totally different person, animated and even screaming and yelling when discussing upcoming games and the handicapping implications. On one follow-up visit months later, I noticed he was down. He confided to me that he took my advice and went for a general physical exam and had some abnormal laboratory results. Subsequent abdominal imaging revealed pseudocysts in the pancreas that would require exploratory surgery. I asked him to keep me updated and gave him my email and cell phone number, just in case he wanted to talk. I remember reassuring them that those are usually benign.

I spent hours reviewing on malignancies of the pancreas and in discussion with gastroenterology colleagues and tried to help with his questions and the inevitable inquires on the probability of this and that. I told him he really should discuss this with his surgeons, but he said he felt much more comfortable talking to me. On the days following his surgery, I kept my phone close, feeling as though I was waiting to talk to someone in own family about the news. He never called but sent  a long email detailing how the surgery was abruptly terminated due to the extensive presence of metastasis, and now he was being encouraged to search for and participate in any relevant clinical trials. I encouraged him to seek out ongoing trials and gave him some pointers. In the ensuing months, I relocated to a different job and the emails gradually stopped coming.

One day, I landed from a flight and there was a voicemail from my patient telling me that he only had another couple days to live but wanted me to know how much I meant to him and how much he appreciated all I did for him. He called me a brother. I kept his emails and voicemail for years after he passed. Unfortunately, I was not able to make it to his funeral.

The next time I was in town visiting friends, I tuned in to his usual radio show time, and I could not believe that the station had replaced him with someone with the same radio nickname and same handicapping shtick. The replacement was even yelling in the same animated fashion. My patient would have gotten a kick out of calculating the odds that he would be replaced by someone who was a virtual replica of himself.

Q. What is your greatest regret?
A. When I look back, I would say I have three big regrets.  My first regret is how much time and energy I  have spent (and spend)  on aspiring for perfection in many aspects of life.  I took too long to realize that everyone of us in this world is imperfect and that we are all in fact  trying to piece it all together as best as we can, and be the best we can – everyday.  Today, with the pervasiveness of social media, where highly curated images of perfect lives and perfect bodies are amplified, it becomes all the more important to remind ourselves (and our patients) that perfection is a myth and that imperfection provides a pathway to continuous improvement, learning and growth.

I would say my second regret is not having kept in better touch with so many wonderful people I have met along life’s journey.  Finally, I am not a natural conversationalist, so I tend to keep things brief when in conversation. My inability be more successful at “talking off-task” has definitely been a challenge and something I am very aware of on a daily basis. Communication and connection are critical life skills and I encourage our visiting residents and fellows to prioritize the development of communication skills sooner rather than later.

Q. Are an understanding & appreciation of the humanities important in dermatology and why?
A. Absolutely. Humanities provide us with very rich context, which in turn allows us to be more empathetic human beings and better physicians. Understanding where my patients are coming from geographically, culturally and philosophically provides me valuable perspective in understanding what their needs are and what is important to them. While many of these understandings develop over time, I take great pride in being able to quickly assess patients needs within the short time we have for reviewing their chart and meeting them. This has proven invaluable in establishing a connection with them as I try to help address their concerns in a stepwise fashion that will work for them and have them leave our office satisfied and feeling heard.