A Conversation With Abraham M. Korman, MD

Q. What part of your work gives you the most pleasure?

A. I enjoy most of what I do, from treating the routine but still satisfying problems to the complex and highly morbid conditions often seen in hospitalized patients. The impact we make on patients’ lives as dermatologists is highly gratifying. I would say, though, that I truly get the most pleasure from teaching. Working at a large medical center, I get the opportunity to work with and teach resident physicians, medical students, and even undergraduate students. I derive particular enjoyment from teaching dermatology residents. It is so much fun to work with them in the clinic or hospital and hear their thought processes as they dissect a patient’s history, formulate differential diagnoses, and design treatment plans. I like to gently probe their understanding of a situation or diagnosis and push them to act decisively and independently, as if I were not there and they were the attending, which, as I like to remind them, in just a few short years they will be. Witnessing a resident’s face light up as a concept clicks or a new diagnosis or treatment is realized is extremely satisfying. Helping a resident get to the (presumed) correct diagnosis rather than just telling them is both challenging and highly rewarding.

Q. Who was your hero/mentor and why?

A. My heroes in my personal life are my parents. They fled the former Soviet Union under duress when they were young adults and started from nothing in this country, achieving the American Dream. My hero and mentor in dermatology is Dr Ben Kaffenberger, who I have known since I was a medical student. When I was a medical student considering dermatology late in my third year, I was having considerable difficulty finding local research projects or clinical mentors. Despite being at a different institution, Dr Kaffenberger took me under his wing and guided me both in terms of research and as a career mentor. I have learned so much from him. He is one of those clinical gurus who is so good at clinical dermatology, differential diagnoses, and morphology that you hold on to every word he says, as every word is purposeful and insightful. He is a big reason why I pursued dermatology residency at Ohio State and subsequently stayed on as faculty. Additionally, I have inherited from him the love of complex medical dermatology and inpatient dermatology, and these are big parts of my clinical and research practices to this day.

Q. Which patient had the most effect on your work and why?

A. When I was an undifferentiated medical student—that is, before I knew I wanted to pursue dermatology—I encountered a case on dermatology consults where we managed a young woman with toxic epidermal necrolysis. The patient had been placed on trimethoprim-sulfamethoxazole for a simple urinary tract infection, and with the help of many teams’ valiant efforts, including dermatology’s, she survived and eventually almost fully recovered. This encounter stuck with for me 2 reasons. For one, before this encounter, I did not know that dermatologists managed “serious” diseases. Indeed, like most medical students, I was under the impression that dermatologists managed only acne and warts, and they never entered the hospital. This was a real eye-opener to me and strongly piqued my interest in dermatology and inpatient dermatology in particular. Secondly, I found it surprising that such a serious and high morbidity disease like toxic epidermal necrolysis had no randomized trials for treatment and was not studied prospectively. As a young medical student, I thought the serious and high morbidity diseases had been figured out and optimized, but not the case! This led me to the realization that I wanted to get my feet wet not just in clinically managing complex and difficult inpatient dermatologic diseases, but also studying them and improving outcomes.

Q. What is the best piece of advice you have received and from whom?

A. The best piece of advice is one that I got as a medical student from a former patient at the Department of Veteran Affairs in Cincinnati. I had walked him out to check out, and he trailed just behind me in his walker. We stood together silently at the checkout desk for about 10 minutes waiting to get the attention of the clerk who was busy typing away without so much as looking up. At some point, the veteran patted me on the back and said, “If you want something, you got to speak up.” He got the clerk’s attention and was appropriately scheduled thereafter. Although it was a small interaction, it really stuck with me. You have got to speak up. This is something I think about and try to incorporate daily, from advocating on behalf of patients with insurance companies, to taking that extra moment to teach a resident a clinical pearl, to advocating for dermatologists to have a greater presence in the hospital. Nothing (or almost nothing) just falls into our laps, so I think his advice rings true today. Medicine has high inertia; we must be proactive and speak up, often repeatedly, if we want to accomplish or change something.

Q. What is the greatest political danger in the field of dermatology?

A. I am biased as an inpatient-oriented dermatologist, but I think the greatest danger in dermatology is losing our foothold in the house of medicine. Fewer and fewer dermatologists are performing inpatient consults as time goes on (unpublished data). Additionally, those who do inpatient consults are concentrated around major urban centers, neglecting rural settings. As we step away from the hospital and more to clinic settings, there are many repercussions. First and foremost, patients suffer. Many studies show that the presence of inpatient dermatology positively impacts length of stay in conditions like cellulitis, among others. Additionally, education suffers. If we are not trained or comfortable in managing complex inpatient dermatologic diagnoses, then the residents we teach will not be, and before we know it there may be a generation of dermatologists not comfortable in managing this population. Further, our specialty suffers. Payers and other stakeholders may view our specialty as less serious and we may be left out, financially or otherwise, of the conversation in the inpatient setting. Other specialists may exclude us from studies or trials on diseases for which we have the potential to have great impact, such as cellulitis, DRESS syndrome, and Stevens-Johnson syndrome. Finally, as noted above, if I had not seen how dermatology impacted a case in the hospital, I probably would not be a dermatologist. I want the next generation to also become inspired.

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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.