Business of Medicine

With physicians under increasing pressure to see more patients in shorter office visits, developing a social media presence may offer valuable opportunities to connect with patients, explain procedures, combat misinformation, talk through a published article, and even share a joke or meme.

But there are caveats for doctors posting on social media platforms. This news organization spoke to four doctors who successfully use social media. Here is what they want you to know before you post – and how to make your posts personable and helpful to patients and your practice simultaneously.
 

Use social media for the right reasons

While you’re under no obligation to build a social media presence, if you’re going to do it, be sure your intentions are solid, said Don S. Dizon, MD, professor of medicine and professor of surgery at Brown University, Providence, R.I. Dr. Dizon, as @DoctorDon, has 44,700 TikTok followers and uses the platform to answer cancer-related questions.

“It should be your altruism that motivates you to post,” said Dr. Dizon, who is also associate director of community outreach and engagement at the Legorreta Cancer Center in Providence, R.I., and director of medical oncology at Rhode Island Hospital. “What we can do for society at large is to provide our input into issues, add informed opinions where there’s controversy, and address misinformation.”

If you don’t know where to start, consider seeking a digital mentor to talk through your options.

“You may never meet this person, but you should choose them if you like their style, their content, their delivery, and their perspective,” Dr. Dizon said. “Find another doctor out there on social media whom you feel you can emulate. Take your time, too. Soon enough, you’ll develop your own style and your own online persona.”
 

Post clear, accurate information

If you want to be lighthearted on social media, that’s your choice. But Jennifer Trachtenberg, a pediatrician with nearly 7,000 Instagram followers in New York who posts as @askdrjen, prefers to offer vaccine scheduling tips, alert parents about COVID-19 rates, and offer advice on cold and flu prevention.

“Right now, I’m mainly doing this to educate patients and make them aware of topics that I think are important and that I see my patients needing more information on,” she said. “We have to be clear: People take what we say seriously. So, while it’s important to be relatable, it’s even more important to share evidence-based information.”
 

Many patients get their information on social media

While patients once came to the doctor armed with information sourced via “Doctor Google,” today, just as many patients use social media to learn about their condition or the medications they’re taking.

Unfortunately, a recent Ohio State University, Columbus, study found that the majority of gynecologic cancer advice on TikTok, for example, was either misleading or inaccurate.

“This misinformation should be a motivator for physicians to explore the social media space,” Dr. Dizon said. “Our voices need to be on there.”
 

Break down barriers – and make connections

Mike Natter, MD, an endocrinologist in New York, has type 1 diabetes. This informs his work – and his life – and he’s passionate about sharing it with his 117,000 followers as @mike.natter on Instagram.

“A lot of type 1s follow me, so there’s an advocacy component to what I do,” he said. “I enjoy being able to raise awareness and keep people up to date on the newest research and treatment.”

But that’s not all: Dr. Natter is also an artist who went to art school before he went to medical school, and his account is rife with his cartoons and illustrations about everything from valvular disease to diabetic ketoacidosis.

“I found that I was drawing a lot of my notes in medical school,” he said. “When I drew my notes, I did quite well, and I think that using art and illustration is a great tool. It breaks down barriers and makes health information all the more accessible to everyone.”
 

Share your expertise as a doctor – and a person

As a mom and pediatrician, Krupa Playforth, MD, who practices in Vienna, Va., knows that what she posts carries weight. So, whether she’s writing about backpack safety tips, choking hazards, or separation anxiety, her followers can rest assured that she’s posting responsibly.

“Pediatricians often underestimate how smart parents are,” said Dr. Playforth, who has three kids, ages 8, 5, and 2, and has 137,000 followers on @thepediatricianmom, her Instagram account. “Their anxiety comes from an understandable place, which is why I see my role as that of a parent and pediatrician who can translate the knowledge pediatricians have into something parents can understand.”

Dr. Playforth, who jumped on social media during COVID-19 and experienced a positive response in her local community, said being on social media is imperative if you’re a pediatrician.

“This is the future of pediatric medicine in particular,” she said. “A lot of pediatricians don’t want to embrace social media, but I think that’s a mistake. After all, while parents think pediatricians have all the answers, when we think of our own children, most doctors are like other parents – we can’t think objectively about our kids. It’s helpful for me to share that and to help parents feel less alone.”

If you’re not yet using social media to the best of your physician abilities, you might take a shot at becoming widely recognizable. Pick a preferred platform, answer common patient questions, dispel medical myths, provide pertinent information, and let your personality shine.

A version of this article first appeared on Medscape.com.

With physicians under increasing pressure to see more patients in shorter office visits, developing a social media presence may offer valuable opportunities to connect with patients, explain procedures, combat misinformation, talk through a published article, and even share a joke or meme.

But there are caveats for doctors posting on social media platforms. This news organization spoke to four doctors who successfully use social media. Here is what they want you to know before you post – and how to make your posts personable and helpful to patients and your practice simultaneously.
 

Use social media for the right reasons

While you’re under no obligation to build a social media presence, if you’re going to do it, be sure your intentions are solid, said Don S. Dizon, MD, professor of medicine and professor of surgery at Brown University, Providence, R.I. Dr. Dizon, as @DoctorDon, has 44,700 TikTok followers and uses the platform to answer cancer-related questions.

“It should be your altruism that motivates you to post,” said Dr. Dizon, who is also associate director of community outreach and engagement at the Legorreta Cancer Center in Providence, R.I., and director of medical oncology at Rhode Island Hospital. “What we can do for society at large is to provide our input into issues, add informed opinions where there’s controversy, and address misinformation.”

If you don’t know where to start, consider seeking a digital mentor to talk through your options.

“You may never meet this person, but you should choose them if you like their style, their content, their delivery, and their perspective,” Dr. Dizon said. “Find another doctor out there on social media whom you feel you can emulate. Take your time, too. Soon enough, you’ll develop your own style and your own online persona.”
 

Post clear, accurate information

If you want to be lighthearted on social media, that’s your choice. But Jennifer Trachtenberg, a pediatrician with nearly 7,000 Instagram followers in New York who posts as @askdrjen, prefers to offer vaccine scheduling tips, alert parents about COVID-19 rates, and offer advice on cold and flu prevention.

“Right now, I’m mainly doing this to educate patients and make them aware of topics that I think are important and that I see my patients needing more information on,” she said. “We have to be clear: People take what we say seriously. So, while it’s important to be relatable, it’s even more important to share evidence-based information.”
 

Many patients get their information on social media

While patients once came to the doctor armed with information sourced via “Doctor Google,” today, just as many patients use social media to learn about their condition or the medications they’re taking.

Unfortunately, a recent Ohio State University, Columbus, study found that the majority of gynecologic cancer advice on TikTok, for example, was either misleading or inaccurate.

“This misinformation should be a motivator for physicians to explore the social media space,” Dr. Dizon said. “Our voices need to be on there.”
 

Break down barriers – and make connections

Mike Natter, MD, an endocrinologist in New York, has type 1 diabetes. This informs his work – and his life – and he’s passionate about sharing it with his 117,000 followers as @mike.natter on Instagram.

“A lot of type 1s follow me, so there’s an advocacy component to what I do,” he said. “I enjoy being able to raise awareness and keep people up to date on the newest research and treatment.”

But that’s not all: Dr. Natter is also an artist who went to art school before he went to medical school, and his account is rife with his cartoons and illustrations about everything from valvular disease to diabetic ketoacidosis.

“I found that I was drawing a lot of my notes in medical school,” he said. “When I drew my notes, I did quite well, and I think that using art and illustration is a great tool. It breaks down barriers and makes health information all the more accessible to everyone.”
 

Share your expertise as a doctor – and a person

As a mom and pediatrician, Krupa Playforth, MD, who practices in Vienna, Va., knows that what she posts carries weight. So, whether she’s writing about backpack safety tips, choking hazards, or separation anxiety, her followers can rest assured that she’s posting responsibly.

“Pediatricians often underestimate how smart parents are,” said Dr. Playforth, who has three kids, ages 8, 5, and 2, and has 137,000 followers on @thepediatricianmom, her Instagram account. “Their anxiety comes from an understandable place, which is why I see my role as that of a parent and pediatrician who can translate the knowledge pediatricians have into something parents can understand.”

Dr. Playforth, who jumped on social media during COVID-19 and experienced a positive response in her local community, said being on social media is imperative if you’re a pediatrician.

“This is the future of pediatric medicine in particular,” she said. “A lot of pediatricians don’t want to embrace social media, but I think that’s a mistake. After all, while parents think pediatricians have all the answers, when we think of our own children, most doctors are like other parents – we can’t think objectively about our kids. It’s helpful for me to share that and to help parents feel less alone.”

If you’re not yet using social media to the best of your physician abilities, you might take a shot at becoming widely recognizable. Pick a preferred platform, answer common patient questions, dispel medical myths, provide pertinent information, and let your personality shine.

A version of this article first appeared on Medscape.com.

With physicians under increasing pressure to see more patients in shorter office visits, developing a social media presence may offer valuable opportunities to connect with patients, explain procedures, combat misinformation, talk through a published article, and even share a joke or meme.

But there are caveats for doctors posting on social media platforms. This news organization spoke to four doctors who successfully use social media. Here is what they want you to know before you post – and how to make your posts personable and helpful to patients and your practice simultaneously.
 

Use social media for the right reasons

While you’re under no obligation to build a social media presence, if you’re going to do it, be sure your intentions are solid, said Don S. Dizon, MD, professor of medicine and professor of surgery at Brown University, Providence, R.I. Dr. Dizon, as @DoctorDon, has 44,700 TikTok followers and uses the platform to answer cancer-related questions.

“It should be your altruism that motivates you to post,” said Dr. Dizon, who is also associate director of community outreach and engagement at the Legorreta Cancer Center in Providence, R.I., and director of medical oncology at Rhode Island Hospital. “What we can do for society at large is to provide our input into issues, add informed opinions where there’s controversy, and address misinformation.”

If you don’t know where to start, consider seeking a digital mentor to talk through your options.

“You may never meet this person, but you should choose them if you like their style, their content, their delivery, and their perspective,” Dr. Dizon said. “Find another doctor out there on social media whom you feel you can emulate. Take your time, too. Soon enough, you’ll develop your own style and your own online persona.”
 

Post clear, accurate information

If you want to be lighthearted on social media, that’s your choice. But Jennifer Trachtenberg, a pediatrician with nearly 7,000 Instagram followers in New York who posts as @askdrjen, prefers to offer vaccine scheduling tips, alert parents about COVID-19 rates, and offer advice on cold and flu prevention.

“Right now, I’m mainly doing this to educate patients and make them aware of topics that I think are important and that I see my patients needing more information on,” she said. “We have to be clear: People take what we say seriously. So, while it’s important to be relatable, it’s even more important to share evidence-based information.”
 

Many patients get their information on social media

While patients once came to the doctor armed with information sourced via “Doctor Google,” today, just as many patients use social media to learn about their condition or the medications they’re taking.

Unfortunately, a recent Ohio State University, Columbus, study found that the majority of gynecologic cancer advice on TikTok, for example, was either misleading or inaccurate.

“This misinformation should be a motivator for physicians to explore the social media space,” Dr. Dizon said. “Our voices need to be on there.”
 

Break down barriers – and make connections

Mike Natter, MD, an endocrinologist in New York, has type 1 diabetes. This informs his work – and his life – and he’s passionate about sharing it with his 117,000 followers as @mike.natter on Instagram.

“A lot of type 1s follow me, so there’s an advocacy component to what I do,” he said. “I enjoy being able to raise awareness and keep people up to date on the newest research and treatment.”

But that’s not all: Dr. Natter is also an artist who went to art school before he went to medical school, and his account is rife with his cartoons and illustrations about everything from valvular disease to diabetic ketoacidosis.

“I found that I was drawing a lot of my notes in medical school,” he said. “When I drew my notes, I did quite well, and I think that using art and illustration is a great tool. It breaks down barriers and makes health information all the more accessible to everyone.”
 

Share your expertise as a doctor – and a person

As a mom and pediatrician, Krupa Playforth, MD, who practices in Vienna, Va., knows that what she posts carries weight. So, whether she’s writing about backpack safety tips, choking hazards, or separation anxiety, her followers can rest assured that she’s posting responsibly.

“Pediatricians often underestimate how smart parents are,” said Dr. Playforth, who has three kids, ages 8, 5, and 2, and has 137,000 followers on @thepediatricianmom, her Instagram account. “Their anxiety comes from an understandable place, which is why I see my role as that of a parent and pediatrician who can translate the knowledge pediatricians have into something parents can understand.”

Dr. Playforth, who jumped on social media during COVID-19 and experienced a positive response in her local community, said being on social media is imperative if you’re a pediatrician.

“This is the future of pediatric medicine in particular,” she said. “A lot of pediatricians don’t want to embrace social media, but I think that’s a mistake. After all, while parents think pediatricians have all the answers, when we think of our own children, most doctors are like other parents – we can’t think objectively about our kids. It’s helpful for me to share that and to help parents feel less alone.”

If you’re not yet using social media to the best of your physician abilities, you might take a shot at becoming widely recognizable. Pick a preferred platform, answer common patient questions, dispel medical myths, provide pertinent information, and let your personality shine.

A version of this article first appeared on Medscape.com.

The updated draft recommendation from the U.S. Preventive Services Task Force that would lower the recommended start age for routine screening mammograms by a decade for all average-risk women is not justified, experts argue in a “dissenting view” published in the New England Journal of Medicine.

The proposed change would affect more than 20 million U.S. women, and it’s “hard to see any potential benefits associated with lowering the starting age,” coauthor Steven Woloshin, MD, with Dartmouth Cancer Center, Lebanon, N.H., said in an NEJM podcast.

Back in May, when USPSTF released the draft recommendation, task force member John Wong, MD, with Tufts Medical Center, Boston, said in an interview, “It is now clear that screening every other year starting at age 40 has the potential to save about 20% more lives among all women.”

But, according to Dr. Woloshin, there is no recent evidence that mortality from breast cancer is increasing in young women.

In fact, the United States has seen a steady decrease in breast cancer mortality, especially among younger women. Breast cancer mortality among women under 50 “has been cut in half over the past 30 years,” Dr. Woloshin and coauthors explained.

Another wrinkle: The task force did not base its recent recommendation on randomized trial data. In fact, there have been no new randomized trials of screening mammography for women in their 40s since 2016. Instead, the task force relied on statistical models to “estimate what might happen if the starting age were lowered,” Dr. Woloshin and colleagues said.

Relying on a statistical model, however, “is problematic because it has some very optimistic assumptions about the benefit of mammography,” Dr. Woloshin said in the podcast. For instance, the models assume that screening mammography reduces breast cancer mortality by about 25%.

That 25% reduction is “far greater than what’s reported in the meta-analyses of the available randomized trials,” Dr. Woloshin explained. The meta-analyses report about a 16% reduction for all the trials combined and an estimated 13% for trials at low risk of bias. But “even these meta-analyses are likely to overstate the effect of screening since the trials were done before the major advances in treatment.”

In their own calculations, Dr. Woloshin and colleagues found that lowering the screening age to 40 came with a small potential benefit and a substantial risk for harm.

Combing data from the National Cancer Institute, the team reported that the risk for death for women in their 40s from any cause over the next 10 years was about 3% whether or not they received their biennial mammogram.

The risk for death from breast cancer in that time was 0.23% with mammograms – about 2 in every 1,000 women – and 0.31% without. “That’s 1 less breast cancer death per 1,000 women screened for 10 years,” Dr. Woloshin said.

Put another way, with mammography screening, “the chance of not dying from breast cancer over the next 10 years increases from 99.7% to 99.8%,” Dr. Woloshin said.

The benefit is arguably small, while the harms appear quite significant, Dr. Woloshin said. About 36% of women who begin screening at age 40 would have at least one false alarm over 10 years, and almost 7% would have a false alarm requiring a biopsy in that time frame.
 

Ease or exacerbate racial disparity?

Another argument that the USPSTF highlighted for lowering the screening age: Research indicates that Black women get breast cancer at younger ages and are more likely to die of the disease, compared with White women.

Dr. Woloshin and coauthors, however, also took issue with the view that lowering the screening age could reduce disparities between Black and White women.

“There’s no question that there are substantial differences between Black and White women in terms of breast cancer mortality, but there’s actually very little disparity in breast cancer screening – about 60% of Black and White women in their 40s are screened regularly in the United States,” Dr. Woloshin explained in the podcast.

Therefore, it’s “really hard to imagine” how recommending the same intervention to both groups could possibly reduce the disparity, he said.

“The disparity is not a reflection of screening. It reflects differences in cancer biology,” he added. “Black women are at higher risk for more aggressive, fast-growing cancers that are less likely to be caught by screening and unfortunately are less likely to benefit from treatment.”

Earlier screening would also not address the problems facing poor women, who tend to be disproportionately Black, such as lower quality of available medical services, follow-up delays after abnormal scans, treatment delays, and less use of adjuvant therapy, Dr. Woloshin cautioned.

In Dr. Woloshin’s view, lowering the screening age, which broadens the eligible population, may actually “exacerbate problems contributing to disparity by diverting resources toward expanded screening rather than doing what we know works by ensuring that high-quality treatments are more readily accessible to poor women with breast cancer.”
 

Reconsider the change?

Because task force recommendations are so influential, Dr. Woloshin and colleagues worry that mammography screening for women in their 40s will probably become a performance measure.

“Our concern is that, rather than fostering informed decisions, clinicians and practices are going to be judged and rewarded and punished based on compliance with this quality metric,” Dr. Woloshin said.

That’s a problem, he noted, “because women should be able to make the decision for themselves rather than having this be a public health imperative, which is imposed by physicians and practices who are incentivized to meet a quality metric.”

The hope, said Dr. Woloshin, is that this prospective piece will help influence the task force to “reconsider the recommendation, because we think that the bottom line is that their models are insufficient to support a new imperative. The benefits are really limited, and there are really common and important harms for healthy women.”

The comment period for the draft recommendation is now closed, and a final decision from the task force is forthcoming.

The research had no funding. Dr. Woloshin has no relevant disclosures.

A version of this article first appeared on Medscape.com.

The updated draft recommendation from the U.S. Preventive Services Task Force that would lower the recommended start age for routine screening mammograms by a decade for all average-risk women is not justified, experts argue in a “dissenting view” published in the New England Journal of Medicine.

The proposed change would affect more than 20 million U.S. women, and it’s “hard to see any potential benefits associated with lowering the starting age,” coauthor Steven Woloshin, MD, with Dartmouth Cancer Center, Lebanon, N.H., said in an NEJM podcast.

Back in May, when USPSTF released the draft recommendation, task force member John Wong, MD, with Tufts Medical Center, Boston, said in an interview, “It is now clear that screening every other year starting at age 40 has the potential to save about 20% more lives among all women.”

But, according to Dr. Woloshin, there is no recent evidence that mortality from breast cancer is increasing in young women.

In fact, the United States has seen a steady decrease in breast cancer mortality, especially among younger women. Breast cancer mortality among women under 50 “has been cut in half over the past 30 years,” Dr. Woloshin and coauthors explained.

Another wrinkle: The task force did not base its recent recommendation on randomized trial data. In fact, there have been no new randomized trials of screening mammography for women in their 40s since 2016. Instead, the task force relied on statistical models to “estimate what might happen if the starting age were lowered,” Dr. Woloshin and colleagues said.

Relying on a statistical model, however, “is problematic because it has some very optimistic assumptions about the benefit of mammography,” Dr. Woloshin said in the podcast. For instance, the models assume that screening mammography reduces breast cancer mortality by about 25%.

That 25% reduction is “far greater than what’s reported in the meta-analyses of the available randomized trials,” Dr. Woloshin explained. The meta-analyses report about a 16% reduction for all the trials combined and an estimated 13% for trials at low risk of bias. But “even these meta-analyses are likely to overstate the effect of screening since the trials were done before the major advances in treatment.”

In their own calculations, Dr. Woloshin and colleagues found that lowering the screening age to 40 came with a small potential benefit and a substantial risk for harm.

Combing data from the National Cancer Institute, the team reported that the risk for death for women in their 40s from any cause over the next 10 years was about 3% whether or not they received their biennial mammogram.

The risk for death from breast cancer in that time was 0.23% with mammograms – about 2 in every 1,000 women – and 0.31% without. “That’s 1 less breast cancer death per 1,000 women screened for 10 years,” Dr. Woloshin said.

Put another way, with mammography screening, “the chance of not dying from breast cancer over the next 10 years increases from 99.7% to 99.8%,” Dr. Woloshin said.

The benefit is arguably small, while the harms appear quite significant, Dr. Woloshin said. About 36% of women who begin screening at age 40 would have at least one false alarm over 10 years, and almost 7% would have a false alarm requiring a biopsy in that time frame.
 

Ease or exacerbate racial disparity?

Another argument that the USPSTF highlighted for lowering the screening age: Research indicates that Black women get breast cancer at younger ages and are more likely to die of the disease, compared with White women.

Dr. Woloshin and coauthors, however, also took issue with the view that lowering the screening age could reduce disparities between Black and White women.

“There’s no question that there are substantial differences between Black and White women in terms of breast cancer mortality, but there’s actually very little disparity in breast cancer screening – about 60% of Black and White women in their 40s are screened regularly in the United States,” Dr. Woloshin explained in the podcast.

Therefore, it’s “really hard to imagine” how recommending the same intervention to both groups could possibly reduce the disparity, he said.

“The disparity is not a reflection of screening. It reflects differences in cancer biology,” he added. “Black women are at higher risk for more aggressive, fast-growing cancers that are less likely to be caught by screening and unfortunately are less likely to benefit from treatment.”

Earlier screening would also not address the problems facing poor women, who tend to be disproportionately Black, such as lower quality of available medical services, follow-up delays after abnormal scans, treatment delays, and less use of adjuvant therapy, Dr. Woloshin cautioned.

In Dr. Woloshin’s view, lowering the screening age, which broadens the eligible population, may actually “exacerbate problems contributing to disparity by diverting resources toward expanded screening rather than doing what we know works by ensuring that high-quality treatments are more readily accessible to poor women with breast cancer.”
 

Reconsider the change?

Because task force recommendations are so influential, Dr. Woloshin and colleagues worry that mammography screening for women in their 40s will probably become a performance measure.

“Our concern is that, rather than fostering informed decisions, clinicians and practices are going to be judged and rewarded and punished based on compliance with this quality metric,” Dr. Woloshin said.

That’s a problem, he noted, “because women should be able to make the decision for themselves rather than having this be a public health imperative, which is imposed by physicians and practices who are incentivized to meet a quality metric.”

The hope, said Dr. Woloshin, is that this prospective piece will help influence the task force to “reconsider the recommendation, because we think that the bottom line is that their models are insufficient to support a new imperative. The benefits are really limited, and there are really common and important harms for healthy women.”

The comment period for the draft recommendation is now closed, and a final decision from the task force is forthcoming.

The research had no funding. Dr. Woloshin has no relevant disclosures.

A version of this article first appeared on Medscape.com.

The updated draft recommendation from the U.S. Preventive Services Task Force that would lower the recommended start age for routine screening mammograms by a decade for all average-risk women is not justified, experts argue in a “dissenting view” published in the New England Journal of Medicine.

The proposed change would affect more than 20 million U.S. women, and it’s “hard to see any potential benefits associated with lowering the starting age,” coauthor Steven Woloshin, MD, with Dartmouth Cancer Center, Lebanon, N.H., said in an NEJM podcast.

Back in May, when USPSTF released the draft recommendation, task force member John Wong, MD, with Tufts Medical Center, Boston, said in an interview, “It is now clear that screening every other year starting at age 40 has the potential to save about 20% more lives among all women.”

But, according to Dr. Woloshin, there is no recent evidence that mortality from breast cancer is increasing in young women.

In fact, the United States has seen a steady decrease in breast cancer mortality, especially among younger women. Breast cancer mortality among women under 50 “has been cut in half over the past 30 years,” Dr. Woloshin and coauthors explained.

Another wrinkle: The task force did not base its recent recommendation on randomized trial data. In fact, there have been no new randomized trials of screening mammography for women in their 40s since 2016. Instead, the task force relied on statistical models to “estimate what might happen if the starting age were lowered,” Dr. Woloshin and colleagues said.

Relying on a statistical model, however, “is problematic because it has some very optimistic assumptions about the benefit of mammography,” Dr. Woloshin said in the podcast. For instance, the models assume that screening mammography reduces breast cancer mortality by about 25%.

That 25% reduction is “far greater than what’s reported in the meta-analyses of the available randomized trials,” Dr. Woloshin explained. The meta-analyses report about a 16% reduction for all the trials combined and an estimated 13% for trials at low risk of bias. But “even these meta-analyses are likely to overstate the effect of screening since the trials were done before the major advances in treatment.”

In their own calculations, Dr. Woloshin and colleagues found that lowering the screening age to 40 came with a small potential benefit and a substantial risk for harm.

Combing data from the National Cancer Institute, the team reported that the risk for death for women in their 40s from any cause over the next 10 years was about 3% whether or not they received their biennial mammogram.

The risk for death from breast cancer in that time was 0.23% with mammograms – about 2 in every 1,000 women – and 0.31% without. “That’s 1 less breast cancer death per 1,000 women screened for 10 years,” Dr. Woloshin said.

Put another way, with mammography screening, “the chance of not dying from breast cancer over the next 10 years increases from 99.7% to 99.8%,” Dr. Woloshin said.

The benefit is arguably small, while the harms appear quite significant, Dr. Woloshin said. About 36% of women who begin screening at age 40 would have at least one false alarm over 10 years, and almost 7% would have a false alarm requiring a biopsy in that time frame.
 

Ease or exacerbate racial disparity?

Another argument that the USPSTF highlighted for lowering the screening age: Research indicates that Black women get breast cancer at younger ages and are more likely to die of the disease, compared with White women.

Dr. Woloshin and coauthors, however, also took issue with the view that lowering the screening age could reduce disparities between Black and White women.

“There’s no question that there are substantial differences between Black and White women in terms of breast cancer mortality, but there’s actually very little disparity in breast cancer screening – about 60% of Black and White women in their 40s are screened regularly in the United States,” Dr. Woloshin explained in the podcast.

Therefore, it’s “really hard to imagine” how recommending the same intervention to both groups could possibly reduce the disparity, he said.

“The disparity is not a reflection of screening. It reflects differences in cancer biology,” he added. “Black women are at higher risk for more aggressive, fast-growing cancers that are less likely to be caught by screening and unfortunately are less likely to benefit from treatment.”

Earlier screening would also not address the problems facing poor women, who tend to be disproportionately Black, such as lower quality of available medical services, follow-up delays after abnormal scans, treatment delays, and less use of adjuvant therapy, Dr. Woloshin cautioned.

In Dr. Woloshin’s view, lowering the screening age, which broadens the eligible population, may actually “exacerbate problems contributing to disparity by diverting resources toward expanded screening rather than doing what we know works by ensuring that high-quality treatments are more readily accessible to poor women with breast cancer.”
 

Reconsider the change?

Because task force recommendations are so influential, Dr. Woloshin and colleagues worry that mammography screening for women in their 40s will probably become a performance measure.

“Our concern is that, rather than fostering informed decisions, clinicians and practices are going to be judged and rewarded and punished based on compliance with this quality metric,” Dr. Woloshin said.

That’s a problem, he noted, “because women should be able to make the decision for themselves rather than having this be a public health imperative, which is imposed by physicians and practices who are incentivized to meet a quality metric.”

The hope, said Dr. Woloshin, is that this prospective piece will help influence the task force to “reconsider the recommendation, because we think that the bottom line is that their models are insufficient to support a new imperative. The benefits are really limited, and there are really common and important harms for healthy women.”

The comment period for the draft recommendation is now closed, and a final decision from the task force is forthcoming.

The research had no funding. Dr. Woloshin has no relevant disclosures.

A version of this article first appeared on Medscape.com.

An innovative care model involving an expanded role for advanced practice radiation therapists (APRTs) has improved the quality and efficiency of care and reduced work-related distress among cancer care team members in the radiation oncology department of Mount Sinai Health System in New York.

At a time when clinician burnout is rampant, a novel approach that brings value to both patients and health systems – and helps advance the careers of highly educated and skilled practitioners – represents a welcome step forward, according to Samantha Skubish, MS, RT, chief technical director of radiation oncology and Mount Sinai.

In the new care model, APRTs work alongside radiation oncologists and support “the care of resource-intensive patient populations,” according to the Association of Community Cancer Centers, which recently recognized the Mount Sinai Health System program as a 2023 ACCC Innovator Award winner.

The new and improved “model for continuity of care” with the APRT role has “helped improve the patient experience and create a more streamlined, efficient process while also alleviating some of the burden on our physicians,” Ms. Skubish said in the ACCC press release. She explained that APRTs possess the skills, knowledge, and judgment to provide an elevated level of care, as evidenced by decades of international research.

A 2022 systematic review of APRT-based care models outside the United States explored how the models have worked. Overall, the research shows that such models improve quality, efficiency, wellness, and administrative outcomes, according to investigators.

At Mount Sinai, the first health system to develop the APRT role in the United States, research to demonstrate the benefits of APRT model continues. In 2021, an APRT working group was established to “garner a network of individuals across the country focused on the work to prove the advanced practice radiation therapy model in the U.S.,” according to Danielle McDonagh, MS, RT, Mount Sinai’s clinical coordinator of radiation sciences education and research.

A paper published in May by Ms. McDonagh and colleagues underscored the potential for “positive change and impact” of the APRT care model in radiation oncology.

“We’re all in this current and longstanding crisis of clinician shortages,” Kimberly Smith, MPA, explained in a video introducing the Mount Sinai program.

“If you look at your therapists’ skill set and allow them to work at the top of their license, you can provide a cost-saving solution that lends itself to value-based care,” said Ms. Smith, vice president of radiation oncology services at Mount Sinai.

Indeed, Sheryl Green, MBBCh, professor and medical director of radiation oncology at Mount Sinai, noted that “the APRT has allowed us to really improve the quality of care that we deliver, primarily in the aspects of optimizing and personalizing the patient experience.”

Ms. Skubish and Ms. Smith will share details of the new care model at the ACCC’s upcoming National Oncology Conference.

An innovative care model involving an expanded role for advanced practice radiation therapists (APRTs) has improved the quality and efficiency of care and reduced work-related distress among cancer care team members in the radiation oncology department of Mount Sinai Health System in New York.

At a time when clinician burnout is rampant, a novel approach that brings value to both patients and health systems – and helps advance the careers of highly educated and skilled practitioners – represents a welcome step forward, according to Samantha Skubish, MS, RT, chief technical director of radiation oncology and Mount Sinai.

In the new care model, APRTs work alongside radiation oncologists and support “the care of resource-intensive patient populations,” according to the Association of Community Cancer Centers, which recently recognized the Mount Sinai Health System program as a 2023 ACCC Innovator Award winner.

The new and improved “model for continuity of care” with the APRT role has “helped improve the patient experience and create a more streamlined, efficient process while also alleviating some of the burden on our physicians,” Ms. Skubish said in the ACCC press release. She explained that APRTs possess the skills, knowledge, and judgment to provide an elevated level of care, as evidenced by decades of international research.

A 2022 systematic review of APRT-based care models outside the United States explored how the models have worked. Overall, the research shows that such models improve quality, efficiency, wellness, and administrative outcomes, according to investigators.

At Mount Sinai, the first health system to develop the APRT role in the United States, research to demonstrate the benefits of APRT model continues. In 2021, an APRT working group was established to “garner a network of individuals across the country focused on the work to prove the advanced practice radiation therapy model in the U.S.,” according to Danielle McDonagh, MS, RT, Mount Sinai’s clinical coordinator of radiation sciences education and research.

A paper published in May by Ms. McDonagh and colleagues underscored the potential for “positive change and impact” of the APRT care model in radiation oncology.

“We’re all in this current and longstanding crisis of clinician shortages,” Kimberly Smith, MPA, explained in a video introducing the Mount Sinai program.

“If you look at your therapists’ skill set and allow them to work at the top of their license, you can provide a cost-saving solution that lends itself to value-based care,” said Ms. Smith, vice president of radiation oncology services at Mount Sinai.

Indeed, Sheryl Green, MBBCh, professor and medical director of radiation oncology at Mount Sinai, noted that “the APRT has allowed us to really improve the quality of care that we deliver, primarily in the aspects of optimizing and personalizing the patient experience.”

Ms. Skubish and Ms. Smith will share details of the new care model at the ACCC’s upcoming National Oncology Conference.

An innovative care model involving an expanded role for advanced practice radiation therapists (APRTs) has improved the quality and efficiency of care and reduced work-related distress among cancer care team members in the radiation oncology department of Mount Sinai Health System in New York.

At a time when clinician burnout is rampant, a novel approach that brings value to both patients and health systems – and helps advance the careers of highly educated and skilled practitioners – represents a welcome step forward, according to Samantha Skubish, MS, RT, chief technical director of radiation oncology and Mount Sinai.

In the new care model, APRTs work alongside radiation oncologists and support “the care of resource-intensive patient populations,” according to the Association of Community Cancer Centers, which recently recognized the Mount Sinai Health System program as a 2023 ACCC Innovator Award winner.

The new and improved “model for continuity of care” with the APRT role has “helped improve the patient experience and create a more streamlined, efficient process while also alleviating some of the burden on our physicians,” Ms. Skubish said in the ACCC press release. She explained that APRTs possess the skills, knowledge, and judgment to provide an elevated level of care, as evidenced by decades of international research.

A 2022 systematic review of APRT-based care models outside the United States explored how the models have worked. Overall, the research shows that such models improve quality, efficiency, wellness, and administrative outcomes, according to investigators.

At Mount Sinai, the first health system to develop the APRT role in the United States, research to demonstrate the benefits of APRT model continues. In 2021, an APRT working group was established to “garner a network of individuals across the country focused on the work to prove the advanced practice radiation therapy model in the U.S.,” according to Danielle McDonagh, MS, RT, Mount Sinai’s clinical coordinator of radiation sciences education and research.

A paper published in May by Ms. McDonagh and colleagues underscored the potential for “positive change and impact” of the APRT care model in radiation oncology.

“We’re all in this current and longstanding crisis of clinician shortages,” Kimberly Smith, MPA, explained in a video introducing the Mount Sinai program.

“If you look at your therapists’ skill set and allow them to work at the top of their license, you can provide a cost-saving solution that lends itself to value-based care,” said Ms. Smith, vice president of radiation oncology services at Mount Sinai.

Indeed, Sheryl Green, MBBCh, professor and medical director of radiation oncology at Mount Sinai, noted that “the APRT has allowed us to really improve the quality of care that we deliver, primarily in the aspects of optimizing and personalizing the patient experience.”

Ms. Skubish and Ms. Smith will share details of the new care model at the ACCC’s upcoming National Oncology Conference.

She went by the name “Dr. Roxy” on social media and became something of a sensation on TikTok, where she livestreamed her patients’ operations. Ultimately, however, plastic surgeon Katharine Roxanne Grawe, MD, lost her medical license based partly on her “life-altering, reckless treatment,” heightened by her social media fame. In July, the Ohio state medical board permanently revoked Dr. Grawe’s license after twice reprimanding her for her failure to meet the standard of care. The board also determined that, by livestreaming procedures, she placed her patients in danger of immediate and serious harm.

Although most doctors don’t use social media to the degree that Dr. Grawe did, using the various platforms – from X (formerly Twitter) to Facebook, Instagram, and TikTok – can be a slippery slope. Medscape’s Physician Behavior Report 2023 revealed that doctors have seen their share of unprofessional or offensive social media use from their peers. Nearly 7 in 10 said it is unethical for a doctor to act rudely, offensively, or unprofessionally on social media, even if their medical practice isn’t mentioned. As one physician put it: “Professional is not a 9-to-5 descriptor.”

In today’s world, social media use is almost a given. Doctors must tread cautiously when they approach it – maybe even more so. “There’s still a stigma attached,” said Liudmila Schafer, MD, an oncologist with The Doctor Connect, a career consulting firm. “Physicians face a tougher challenge due to societal expectations of perfection, with greater consequences for mistakes. We’re under constant ‘observation’ from peers, employers, and patients.”

Beverly Hills plastic surgeon Jay Calvert, MD, says he holds firm boundaries with how he uses social media. “I do comedy on the side, but it’s not acceptable for me as a doctor to share that on social media,” he said. “People want doctors who are professional, and I’m always concerned about how I present myself.”

Dr. Calvert said it is fairly easy to spot doctors who cross the line with social media. “You have to hold yourself back when posting. Doing things like dancing in the OR are out of whack with the profession.”

According to Dr. Schafer, a definite line to avoid crossing is offering medical advice or guidance on social media. “You also can’t discuss confidential practice details, respond to unfamiliar contacts, or discuss institutional policies without permission,” she said. “It’s important to add disclaimers if a personal scientific opinion is shared without reference [or] research or with unchecked sources.”
 

Navigating the many social media sites

Each social media platform has its pros and cons. Doctors need to determine why to use them and what the payback of each might be. Dr. Schafer uses multiple sites, including LinkedIn, Facebook, Instagram, X, Threads, YouTube, and, to a lesser degree, Clubhouse. How and what she posts on each varies. “I use them almost 95% professionally,” she said. “It’s challenging to meet and engage in person, so that is where social media helps.”

Stephen Pribut, MD, a Washington-based podiatrist, likes to use X as an information source. He follows pretty simple rules when it comes to what he tweets and shares on various sites: “I stay away from politics and religion,” he said. “I also avoid controversial topics online, such as vaccines.”

Joseph Daibes, DO, who specializes in cardiovascular medicine at New Jersey Heart and Vein, Clifton, said he has changed how he uses social media. “Initially, I was a passive consumer, but as I recognized the importance of accurate medical information online, I became more active in weighing in responsibly, occasionally sharing studies, debunking myths, and engaging in meaningful conversations,” he said. “Social media can get dangerous, so we have a duty to use it responsibly, and I cannot stress that enough.”

For plastic surgeons like Dr. Calvert, the visual platforms such as Instagram can prove invaluable for marketing purposes. “I’ve been using Instagram since 2012, and it’s been my most positive experience,” he said. “I don’t generate business from it, but I use it to back up my qualifications as a surgeon.”

Potential patients like to scroll through posts by plastic surgeons to learn what their finished product looks like, Dr. Calvert said. In many cases, plastic surgeons hire social media experts to cultivate their content. “I’ve hired and fired social media managers over the years, ultimately deciding I should develop my own content,” he said. “I want people to see the same doctor on social media that they will see in the office. I like an authentic presentation, not glitzy.”
 

Social media gone wrong

Dr. Calvert said that in the world of plastic surgery, some doctors use social media to present “before and after” compilations that in his opinion aren’t necessarily fully authentic, and this rubs him wrong. “There’s a bit of ‘cheating’ in some of these posts, using filters, making the ‘befores’ particularly bad, and other tricks,” he said.

Dr. Daibes has also seen his share of social media misuse: ”Red flags include oversharing personal indulgences, engaging in online spats, or making unfounded medical claims,” he said. “It’s essential to remember our role as educators and advocates, and to present ourselves in a way that upholds the dignity of our profession.”

At the end of the day, social media can have positive uses for physicians, and it is clearly here to stay. The onus for responsible use ultimately falls to the physicians using it.

Dr. Daibes emphasizes the fact that a doctor’s words carry weight – perhaps more so than those of other professionals. “The added scrutiny is good because it keeps us accountable; it’s crucial that our information is accurate,” he said. “The downside is that the scrutiny can be stifling at times and lead to self-censorship, even on nonmedical matters.”

Physicians have suggested eight guidelines for doctors to follow when using social media:

• Remember that you represent your profession, even if posting on personal accounts.
• Never post from the operating room, the emergency department, or any sort of medical space.
• If you’re employed, before you post, check with your employer to see whether they have any rules or guidance surrounding social media.
• Never use social media to badmouth colleagues, hospitals, or other healthcare organizations.
• Never use social media to dispense medical advice.
• Steer clear of the obvious hot-button issues, like religion and politics.
• Always protect patient privacy when posting.
• Be careful with how and whom you engage on social media.

A version of this article first appeared on Medscape.com.

She went by the name “Dr. Roxy” on social media and became something of a sensation on TikTok, where she livestreamed her patients’ operations. Ultimately, however, plastic surgeon Katharine Roxanne Grawe, MD, lost her medical license based partly on her “life-altering, reckless treatment,” heightened by her social media fame. In July, the Ohio state medical board permanently revoked Dr. Grawe’s license after twice reprimanding her for her failure to meet the standard of care. The board also determined that, by livestreaming procedures, she placed her patients in danger of immediate and serious harm.

Although most doctors don’t use social media to the degree that Dr. Grawe did, using the various platforms – from X (formerly Twitter) to Facebook, Instagram, and TikTok – can be a slippery slope. Medscape’s Physician Behavior Report 2023 revealed that doctors have seen their share of unprofessional or offensive social media use from their peers. Nearly 7 in 10 said it is unethical for a doctor to act rudely, offensively, or unprofessionally on social media, even if their medical practice isn’t mentioned. As one physician put it: “Professional is not a 9-to-5 descriptor.”

In today’s world, social media use is almost a given. Doctors must tread cautiously when they approach it – maybe even more so. “There’s still a stigma attached,” said Liudmila Schafer, MD, an oncologist with The Doctor Connect, a career consulting firm. “Physicians face a tougher challenge due to societal expectations of perfection, with greater consequences for mistakes. We’re under constant ‘observation’ from peers, employers, and patients.”

Beverly Hills plastic surgeon Jay Calvert, MD, says he holds firm boundaries with how he uses social media. “I do comedy on the side, but it’s not acceptable for me as a doctor to share that on social media,” he said. “People want doctors who are professional, and I’m always concerned about how I present myself.”

Dr. Calvert said it is fairly easy to spot doctors who cross the line with social media. “You have to hold yourself back when posting. Doing things like dancing in the OR are out of whack with the profession.”

According to Dr. Schafer, a definite line to avoid crossing is offering medical advice or guidance on social media. “You also can’t discuss confidential practice details, respond to unfamiliar contacts, or discuss institutional policies without permission,” she said. “It’s important to add disclaimers if a personal scientific opinion is shared without reference [or] research or with unchecked sources.”
 

Navigating the many social media sites

Each social media platform has its pros and cons. Doctors need to determine why to use them and what the payback of each might be. Dr. Schafer uses multiple sites, including LinkedIn, Facebook, Instagram, X, Threads, YouTube, and, to a lesser degree, Clubhouse. How and what she posts on each varies. “I use them almost 95% professionally,” she said. “It’s challenging to meet and engage in person, so that is where social media helps.”

Stephen Pribut, MD, a Washington-based podiatrist, likes to use X as an information source. He follows pretty simple rules when it comes to what he tweets and shares on various sites: “I stay away from politics and religion,” he said. “I also avoid controversial topics online, such as vaccines.”

Joseph Daibes, DO, who specializes in cardiovascular medicine at New Jersey Heart and Vein, Clifton, said he has changed how he uses social media. “Initially, I was a passive consumer, but as I recognized the importance of accurate medical information online, I became more active in weighing in responsibly, occasionally sharing studies, debunking myths, and engaging in meaningful conversations,” he said. “Social media can get dangerous, so we have a duty to use it responsibly, and I cannot stress that enough.”

For plastic surgeons like Dr. Calvert, the visual platforms such as Instagram can prove invaluable for marketing purposes. “I’ve been using Instagram since 2012, and it’s been my most positive experience,” he said. “I don’t generate business from it, but I use it to back up my qualifications as a surgeon.”

Potential patients like to scroll through posts by plastic surgeons to learn what their finished product looks like, Dr. Calvert said. In many cases, plastic surgeons hire social media experts to cultivate their content. “I’ve hired and fired social media managers over the years, ultimately deciding I should develop my own content,” he said. “I want people to see the same doctor on social media that they will see in the office. I like an authentic presentation, not glitzy.”
 

Social media gone wrong

Dr. Calvert said that in the world of plastic surgery, some doctors use social media to present “before and after” compilations that in his opinion aren’t necessarily fully authentic, and this rubs him wrong. “There’s a bit of ‘cheating’ in some of these posts, using filters, making the ‘befores’ particularly bad, and other tricks,” he said.

Dr. Daibes has also seen his share of social media misuse: ”Red flags include oversharing personal indulgences, engaging in online spats, or making unfounded medical claims,” he said. “It’s essential to remember our role as educators and advocates, and to present ourselves in a way that upholds the dignity of our profession.”

At the end of the day, social media can have positive uses for physicians, and it is clearly here to stay. The onus for responsible use ultimately falls to the physicians using it.

Dr. Daibes emphasizes the fact that a doctor’s words carry weight – perhaps more so than those of other professionals. “The added scrutiny is good because it keeps us accountable; it’s crucial that our information is accurate,” he said. “The downside is that the scrutiny can be stifling at times and lead to self-censorship, even on nonmedical matters.”

Physicians have suggested eight guidelines for doctors to follow when using social media:

• Remember that you represent your profession, even if posting on personal accounts.
• Never post from the operating room, the emergency department, or any sort of medical space.
• If you’re employed, before you post, check with your employer to see whether they have any rules or guidance surrounding social media.
• Never use social media to badmouth colleagues, hospitals, or other healthcare organizations.
• Never use social media to dispense medical advice.
• Steer clear of the obvious hot-button issues, like religion and politics.
• Always protect patient privacy when posting.
• Be careful with how and whom you engage on social media.

A version of this article first appeared on Medscape.com.

She went by the name “Dr. Roxy” on social media and became something of a sensation on TikTok, where she livestreamed her patients’ operations. Ultimately, however, plastic surgeon Katharine Roxanne Grawe, MD, lost her medical license based partly on her “life-altering, reckless treatment,” heightened by her social media fame. In July, the Ohio state medical board permanently revoked Dr. Grawe’s license after twice reprimanding her for her failure to meet the standard of care. The board also determined that, by livestreaming procedures, she placed her patients in danger of immediate and serious harm.

Although most doctors don’t use social media to the degree that Dr. Grawe did, using the various platforms – from X (formerly Twitter) to Facebook, Instagram, and TikTok – can be a slippery slope. Medscape’s Physician Behavior Report 2023 revealed that doctors have seen their share of unprofessional or offensive social media use from their peers. Nearly 7 in 10 said it is unethical for a doctor to act rudely, offensively, or unprofessionally on social media, even if their medical practice isn’t mentioned. As one physician put it: “Professional is not a 9-to-5 descriptor.”

In today’s world, social media use is almost a given. Doctors must tread cautiously when they approach it – maybe even more so. “There’s still a stigma attached,” said Liudmila Schafer, MD, an oncologist with The Doctor Connect, a career consulting firm. “Physicians face a tougher challenge due to societal expectations of perfection, with greater consequences for mistakes. We’re under constant ‘observation’ from peers, employers, and patients.”

Beverly Hills plastic surgeon Jay Calvert, MD, says he holds firm boundaries with how he uses social media. “I do comedy on the side, but it’s not acceptable for me as a doctor to share that on social media,” he said. “People want doctors who are professional, and I’m always concerned about how I present myself.”

Dr. Calvert said it is fairly easy to spot doctors who cross the line with social media. “You have to hold yourself back when posting. Doing things like dancing in the OR are out of whack with the profession.”

According to Dr. Schafer, a definite line to avoid crossing is offering medical advice or guidance on social media. “You also can’t discuss confidential practice details, respond to unfamiliar contacts, or discuss institutional policies without permission,” she said. “It’s important to add disclaimers if a personal scientific opinion is shared without reference [or] research or with unchecked sources.”
 

Navigating the many social media sites

Each social media platform has its pros and cons. Doctors need to determine why to use them and what the payback of each might be. Dr. Schafer uses multiple sites, including LinkedIn, Facebook, Instagram, X, Threads, YouTube, and, to a lesser degree, Clubhouse. How and what she posts on each varies. “I use them almost 95% professionally,” she said. “It’s challenging to meet and engage in person, so that is where social media helps.”

Stephen Pribut, MD, a Washington-based podiatrist, likes to use X as an information source. He follows pretty simple rules when it comes to what he tweets and shares on various sites: “I stay away from politics and religion,” he said. “I also avoid controversial topics online, such as vaccines.”

Joseph Daibes, DO, who specializes in cardiovascular medicine at New Jersey Heart and Vein, Clifton, said he has changed how he uses social media. “Initially, I was a passive consumer, but as I recognized the importance of accurate medical information online, I became more active in weighing in responsibly, occasionally sharing studies, debunking myths, and engaging in meaningful conversations,” he said. “Social media can get dangerous, so we have a duty to use it responsibly, and I cannot stress that enough.”

For plastic surgeons like Dr. Calvert, the visual platforms such as Instagram can prove invaluable for marketing purposes. “I’ve been using Instagram since 2012, and it’s been my most positive experience,” he said. “I don’t generate business from it, but I use it to back up my qualifications as a surgeon.”

Potential patients like to scroll through posts by plastic surgeons to learn what their finished product looks like, Dr. Calvert said. In many cases, plastic surgeons hire social media experts to cultivate their content. “I’ve hired and fired social media managers over the years, ultimately deciding I should develop my own content,” he said. “I want people to see the same doctor on social media that they will see in the office. I like an authentic presentation, not glitzy.”
 

Social media gone wrong

Dr. Calvert said that in the world of plastic surgery, some doctors use social media to present “before and after” compilations that in his opinion aren’t necessarily fully authentic, and this rubs him wrong. “There’s a bit of ‘cheating’ in some of these posts, using filters, making the ‘befores’ particularly bad, and other tricks,” he said.

Dr. Daibes has also seen his share of social media misuse: ”Red flags include oversharing personal indulgences, engaging in online spats, or making unfounded medical claims,” he said. “It’s essential to remember our role as educators and advocates, and to present ourselves in a way that upholds the dignity of our profession.”

At the end of the day, social media can have positive uses for physicians, and it is clearly here to stay. The onus for responsible use ultimately falls to the physicians using it.

Dr. Daibes emphasizes the fact that a doctor’s words carry weight – perhaps more so than those of other professionals. “The added scrutiny is good because it keeps us accountable; it’s crucial that our information is accurate,” he said. “The downside is that the scrutiny can be stifling at times and lead to self-censorship, even on nonmedical matters.”

Physicians have suggested eight guidelines for doctors to follow when using social media:

• Remember that you represent your profession, even if posting on personal accounts.
• Never post from the operating room, the emergency department, or any sort of medical space.
• If you’re employed, before you post, check with your employer to see whether they have any rules or guidance surrounding social media.
• Never use social media to badmouth colleagues, hospitals, or other healthcare organizations.
• Never use social media to dispense medical advice.
• Steer clear of the obvious hot-button issues, like religion and politics.
• Always protect patient privacy when posting.
• Be careful with how and whom you engage on social media.

A version of this article first appeared on Medscape.com.

I’ve worked hard to get rid of paper, or at least minimize it.

I use e-fax for sending and receiving as much as possible. I send scripts and order digitally when I can.

But, 23 years into a paperless practice, the stuff isn’t going away soon. Nor I do I want it to.

For many applications paper is just easier (at least to me) to use. When I have a meeting and know I’ll need to read from notes, I’d much rather have them on paper than a screen, so I print them up. Even a grocery list is easier to scribble down on something and look at as I wander the aisles, rather than navigate to an app every 2 minutes. Paper isn’t susceptible to the whims of battery power, signal strength, being dropped, or software glitches.

I’m also not particularly good at taking notes on a computer. I’m sure most of the current generation of physicians is (or they just use a scribe), but I’m old school. Since day one I’ve had a note pad on my desk, jotting points and observations down on the fly (I use a pencil, too, if anyone remembers what that is). Then, when I have time, I type up my notes from the paper.

I also still have patients who, for whatever reason, want a handwritten prescription. Or sometimes need the legendary “doctor’s note” for work or school. Or need me to fill out forms.

Having grown up with paper, and been through school and residency with paper, it’s not easy to give it up entirely. There’s something reassuring about the tactile nature of flipping pages as opposed to scrolling up and down.

I’m not complaining about its decreased use, though. A digital world is, for the most part, much, much easier. Even now paper is just a transient medium for me. It’s either going to be scanned or shredded (or scanned, then shredded) when I’m done. I don’t want the hassle of paper charts as my repository of information. Currently I have 23 years of charts sitting on a Mac-Mini, and accessible from wherever I am on Earth (as long as I have a decent signal). You definitely can’t do that with paper.

On a larger scale paper has other, more significant, drawbacks: deforestation, pollution, freshwater and petroleum usage, and others. I’m aware of this, use only scratch paper for my scribbles and lists, and buy recycled paper products as much as possible.

Certainly I wish we had less use of it. For one thing, I’d love to be rid of all the junk mail that comes to my house, which far outnumbers anything of importance. I always send it straight to recycling, but it would be far better if it had never been created in the first place.

Realistically, though, it’s still a key part of medical practice and everyday life. I don’t see that changing anytime soon, nor do I really want it to. I’ll leave it to a future generation of doctors to make that break.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I’ve worked hard to get rid of paper, or at least minimize it.

I use e-fax for sending and receiving as much as possible. I send scripts and order digitally when I can.

But, 23 years into a paperless practice, the stuff isn’t going away soon. Nor I do I want it to.

For many applications paper is just easier (at least to me) to use. When I have a meeting and know I’ll need to read from notes, I’d much rather have them on paper than a screen, so I print them up. Even a grocery list is easier to scribble down on something and look at as I wander the aisles, rather than navigate to an app every 2 minutes. Paper isn’t susceptible to the whims of battery power, signal strength, being dropped, or software glitches.

I’m also not particularly good at taking notes on a computer. I’m sure most of the current generation of physicians is (or they just use a scribe), but I’m old school. Since day one I’ve had a note pad on my desk, jotting points and observations down on the fly (I use a pencil, too, if anyone remembers what that is). Then, when I have time, I type up my notes from the paper.

I also still have patients who, for whatever reason, want a handwritten prescription. Or sometimes need the legendary “doctor’s note” for work or school. Or need me to fill out forms.

Having grown up with paper, and been through school and residency with paper, it’s not easy to give it up entirely. There’s something reassuring about the tactile nature of flipping pages as opposed to scrolling up and down.

I’m not complaining about its decreased use, though. A digital world is, for the most part, much, much easier. Even now paper is just a transient medium for me. It’s either going to be scanned or shredded (or scanned, then shredded) when I’m done. I don’t want the hassle of paper charts as my repository of information. Currently I have 23 years of charts sitting on a Mac-Mini, and accessible from wherever I am on Earth (as long as I have a decent signal). You definitely can’t do that with paper.

On a larger scale paper has other, more significant, drawbacks: deforestation, pollution, freshwater and petroleum usage, and others. I’m aware of this, use only scratch paper for my scribbles and lists, and buy recycled paper products as much as possible.

Certainly I wish we had less use of it. For one thing, I’d love to be rid of all the junk mail that comes to my house, which far outnumbers anything of importance. I always send it straight to recycling, but it would be far better if it had never been created in the first place.

Realistically, though, it’s still a key part of medical practice and everyday life. I don’t see that changing anytime soon, nor do I really want it to. I’ll leave it to a future generation of doctors to make that break.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I’ve worked hard to get rid of paper, or at least minimize it.

I use e-fax for sending and receiving as much as possible. I send scripts and order digitally when I can.

But, 23 years into a paperless practice, the stuff isn’t going away soon. Nor I do I want it to.

For many applications paper is just easier (at least to me) to use. When I have a meeting and know I’ll need to read from notes, I’d much rather have them on paper than a screen, so I print them up. Even a grocery list is easier to scribble down on something and look at as I wander the aisles, rather than navigate to an app every 2 minutes. Paper isn’t susceptible to the whims of battery power, signal strength, being dropped, or software glitches.

I’m also not particularly good at taking notes on a computer. I’m sure most of the current generation of physicians is (or they just use a scribe), but I’m old school. Since day one I’ve had a note pad on my desk, jotting points and observations down on the fly (I use a pencil, too, if anyone remembers what that is). Then, when I have time, I type up my notes from the paper.

I also still have patients who, for whatever reason, want a handwritten prescription. Or sometimes need the legendary “doctor’s note” for work or school. Or need me to fill out forms.

Having grown up with paper, and been through school and residency with paper, it’s not easy to give it up entirely. There’s something reassuring about the tactile nature of flipping pages as opposed to scrolling up and down.

I’m not complaining about its decreased use, though. A digital world is, for the most part, much, much easier. Even now paper is just a transient medium for me. It’s either going to be scanned or shredded (or scanned, then shredded) when I’m done. I don’t want the hassle of paper charts as my repository of information. Currently I have 23 years of charts sitting on a Mac-Mini, and accessible from wherever I am on Earth (as long as I have a decent signal). You definitely can’t do that with paper.

On a larger scale paper has other, more significant, drawbacks: deforestation, pollution, freshwater and petroleum usage, and others. I’m aware of this, use only scratch paper for my scribbles and lists, and buy recycled paper products as much as possible.

Certainly I wish we had less use of it. For one thing, I’d love to be rid of all the junk mail that comes to my house, which far outnumbers anything of importance. I always send it straight to recycling, but it would be far better if it had never been created in the first place.

Realistically, though, it’s still a key part of medical practice and everyday life. I don’t see that changing anytime soon, nor do I really want it to. I’ll leave it to a future generation of doctors to make that break.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Transgender patients in the United States and Canada told researchers that they often face voyeuristic and stigmatizing treatment in medical clinics and they fear they’re getting substandard care.

“Transgender people feel that their care worsens when clinicians learn that they are transgender, and thus they often have to choose between stigma if clinicians learn that they are transgender and potentially ineffective clinical problem-solving if they do not,” said Yale Cancer Center instructor of medicine Ash B. Alpert, MD, MFA, lead author of the study, which was published in Annals of Family Medicine. For the qualitative study, researchers held seven online focus groups with 30 transgender adults (median age, 31; age range, 20-67; 40% people of color; and 47% with incomes of more than $40,000 a year). All but one were from the United States.

According to the study, the participants said clinicians often ask “irrelevant” questions, sometimes with intentions that appear voyeuristic. “I saw a pulmonologist earlier in the year and one of his first questions was, ‘When are you getting genital surgery?’ and I was like, ‘I’m here for my lungs,’ ” said a White, nonbinary participant. A White male participant said “As soon as I walk in, no matter what I’m there for, the first [order] of business is for them to determine my gender or sex assigned at birth ... and ... once they ... know they’re ... much more at ease.”

Participants also described how medical encounters went awry once clinicians realized they were transgender. “It wasn’t until after I told the doctor that I was on hormones for transition that I started being ‘he’d.’ ” Before that, it was “she,” said a Black transgender woman.

One participant, a Black person who declined to identify by gender, said “I don’t feel comfortable sharing medical records with physicians anyway because it’s a guarantee that I’m not gonna get services. So I lost [my medical records] and they’re good wherever they are now, far away from me.”

Ten participants were clinicians. “Many seemed concerned that transgender people are being put in distressing and difficult situations in medical settings and also seemed dubious that health care for transgender people would improve without a complete overhaul,” Dr. Alpert said.

In an interview, Boston University assistant professor of medicine C. Streed Jr., MD, MPH, who studies gender and health, praised the study. He said it plays an early role in revealing the problems faced by transgender people in the health system.

“We do not fully know the experience of transgender persons accessing care in various contexts, especially in specialty care such as oncology, pulmonology, nephrology, etc.” Dr. Streed said. “We do not know how they identify specialists who are welcoming, compassionate, and competent in care for transgender persons.”

The results aren’t surprising, Dr. Streed said, “given the lack of training in medical school, residency, and fellowship specific to the unique needs of transgender persons.”
 

How can clinicians improve interactions with transgender people?

What can clinicians do to help transgender patients feel comfortable? Dr. Alpert suggested they “ask [only] for medically relevant information and to explain to patients why it is medically relevant.”

“This is important because transgender people are often weighing the risks and benefits of disclosing information that could be used to stigmatize them,” Dr. Alpert said.

What if a clinician wants to create a personal connection with a patient by asking questions about their life? “If you as a clinician think it’s important to ask for nonmedical information to get to know a patient, explicitly clarify that your questions are optional and not medically relevant,” Dr. Alpert said. “That way patients have the ability to consent or not to questions that likely will not directly benefit their care.”

Dr. Streed offered a similar perspective. “Clinicians should only be asking questions of patients that will affect the care the patient is seeking and for which the clinician is trained to provide,” he said. “Having a transgender patient is not an opportunity for a clinician to satisfy their curiosity when it is not related to the care the patient is seeking or needs.”

More specifically, Dr. Streed offered an example: Clinicians should not be asking about a patient’s genitals if they are seeking care related to their asthma diagnosis.

Dr. Streed referred clinicians to resources from the American Medical Association and the Human Rights Campaign for guidelines on caring for transgender patients.

The study was funded by Conquer Cancer. The study authors and Dr. Streed have no relevant disclosures.
 

Transgender patients in the United States and Canada told researchers that they often face voyeuristic and stigmatizing treatment in medical clinics and they fear they’re getting substandard care.

“Transgender people feel that their care worsens when clinicians learn that they are transgender, and thus they often have to choose between stigma if clinicians learn that they are transgender and potentially ineffective clinical problem-solving if they do not,” said Yale Cancer Center instructor of medicine Ash B. Alpert, MD, MFA, lead author of the study, which was published in Annals of Family Medicine. For the qualitative study, researchers held seven online focus groups with 30 transgender adults (median age, 31; age range, 20-67; 40% people of color; and 47% with incomes of more than $40,000 a year). All but one were from the United States.

According to the study, the participants said clinicians often ask “irrelevant” questions, sometimes with intentions that appear voyeuristic. “I saw a pulmonologist earlier in the year and one of his first questions was, ‘When are you getting genital surgery?’ and I was like, ‘I’m here for my lungs,’ ” said a White, nonbinary participant. A White male participant said “As soon as I walk in, no matter what I’m there for, the first [order] of business is for them to determine my gender or sex assigned at birth ... and ... once they ... know they’re ... much more at ease.”

Participants also described how medical encounters went awry once clinicians realized they were transgender. “It wasn’t until after I told the doctor that I was on hormones for transition that I started being ‘he’d.’ ” Before that, it was “she,” said a Black transgender woman.

One participant, a Black person who declined to identify by gender, said “I don’t feel comfortable sharing medical records with physicians anyway because it’s a guarantee that I’m not gonna get services. So I lost [my medical records] and they’re good wherever they are now, far away from me.”

Ten participants were clinicians. “Many seemed concerned that transgender people are being put in distressing and difficult situations in medical settings and also seemed dubious that health care for transgender people would improve without a complete overhaul,” Dr. Alpert said.

In an interview, Boston University assistant professor of medicine C. Streed Jr., MD, MPH, who studies gender and health, praised the study. He said it plays an early role in revealing the problems faced by transgender people in the health system.

“We do not fully know the experience of transgender persons accessing care in various contexts, especially in specialty care such as oncology, pulmonology, nephrology, etc.” Dr. Streed said. “We do not know how they identify specialists who are welcoming, compassionate, and competent in care for transgender persons.”

The results aren’t surprising, Dr. Streed said, “given the lack of training in medical school, residency, and fellowship specific to the unique needs of transgender persons.”
 

How can clinicians improve interactions with transgender people?

What can clinicians do to help transgender patients feel comfortable? Dr. Alpert suggested they “ask [only] for medically relevant information and to explain to patients why it is medically relevant.”

“This is important because transgender people are often weighing the risks and benefits of disclosing information that could be used to stigmatize them,” Dr. Alpert said.

What if a clinician wants to create a personal connection with a patient by asking questions about their life? “If you as a clinician think it’s important to ask for nonmedical information to get to know a patient, explicitly clarify that your questions are optional and not medically relevant,” Dr. Alpert said. “That way patients have the ability to consent or not to questions that likely will not directly benefit their care.”

Dr. Streed offered a similar perspective. “Clinicians should only be asking questions of patients that will affect the care the patient is seeking and for which the clinician is trained to provide,” he said. “Having a transgender patient is not an opportunity for a clinician to satisfy their curiosity when it is not related to the care the patient is seeking or needs.”

More specifically, Dr. Streed offered an example: Clinicians should not be asking about a patient’s genitals if they are seeking care related to their asthma diagnosis.

Dr. Streed referred clinicians to resources from the American Medical Association and the Human Rights Campaign for guidelines on caring for transgender patients.

The study was funded by Conquer Cancer. The study authors and Dr. Streed have no relevant disclosures.
 

Transgender patients in the United States and Canada told researchers that they often face voyeuristic and stigmatizing treatment in medical clinics and they fear they’re getting substandard care.

“Transgender people feel that their care worsens when clinicians learn that they are transgender, and thus they often have to choose between stigma if clinicians learn that they are transgender and potentially ineffective clinical problem-solving if they do not,” said Yale Cancer Center instructor of medicine Ash B. Alpert, MD, MFA, lead author of the study, which was published in Annals of Family Medicine. For the qualitative study, researchers held seven online focus groups with 30 transgender adults (median age, 31; age range, 20-67; 40% people of color; and 47% with incomes of more than $40,000 a year). All but one were from the United States.

According to the study, the participants said clinicians often ask “irrelevant” questions, sometimes with intentions that appear voyeuristic. “I saw a pulmonologist earlier in the year and one of his first questions was, ‘When are you getting genital surgery?’ and I was like, ‘I’m here for my lungs,’ ” said a White, nonbinary participant. A White male participant said “As soon as I walk in, no matter what I’m there for, the first [order] of business is for them to determine my gender or sex assigned at birth ... and ... once they ... know they’re ... much more at ease.”

Participants also described how medical encounters went awry once clinicians realized they were transgender. “It wasn’t until after I told the doctor that I was on hormones for transition that I started being ‘he’d.’ ” Before that, it was “she,” said a Black transgender woman.

One participant, a Black person who declined to identify by gender, said “I don’t feel comfortable sharing medical records with physicians anyway because it’s a guarantee that I’m not gonna get services. So I lost [my medical records] and they’re good wherever they are now, far away from me.”

Ten participants were clinicians. “Many seemed concerned that transgender people are being put in distressing and difficult situations in medical settings and also seemed dubious that health care for transgender people would improve without a complete overhaul,” Dr. Alpert said.

In an interview, Boston University assistant professor of medicine C. Streed Jr., MD, MPH, who studies gender and health, praised the study. He said it plays an early role in revealing the problems faced by transgender people in the health system.

“We do not fully know the experience of transgender persons accessing care in various contexts, especially in specialty care such as oncology, pulmonology, nephrology, etc.” Dr. Streed said. “We do not know how they identify specialists who are welcoming, compassionate, and competent in care for transgender persons.”

The results aren’t surprising, Dr. Streed said, “given the lack of training in medical school, residency, and fellowship specific to the unique needs of transgender persons.”
 

How can clinicians improve interactions with transgender people?

What can clinicians do to help transgender patients feel comfortable? Dr. Alpert suggested they “ask [only] for medically relevant information and to explain to patients why it is medically relevant.”

“This is important because transgender people are often weighing the risks and benefits of disclosing information that could be used to stigmatize them,” Dr. Alpert said.

What if a clinician wants to create a personal connection with a patient by asking questions about their life? “If you as a clinician think it’s important to ask for nonmedical information to get to know a patient, explicitly clarify that your questions are optional and not medically relevant,” Dr. Alpert said. “That way patients have the ability to consent or not to questions that likely will not directly benefit their care.”

Dr. Streed offered a similar perspective. “Clinicians should only be asking questions of patients that will affect the care the patient is seeking and for which the clinician is trained to provide,” he said. “Having a transgender patient is not an opportunity for a clinician to satisfy their curiosity when it is not related to the care the patient is seeking or needs.”

More specifically, Dr. Streed offered an example: Clinicians should not be asking about a patient’s genitals if they are seeking care related to their asthma diagnosis.

Dr. Streed referred clinicians to resources from the American Medical Association and the Human Rights Campaign for guidelines on caring for transgender patients.

The study was funded by Conquer Cancer. The study authors and Dr. Streed have no relevant disclosures.
 

Early Monday morning was my usual start-the-week routine: Set up things at the office, update my computer, check the mail, review the week’s schedule.

I was rolling the phones when a text passed by on my screen that a friend had died.

He wasn’t a close friend, but still someone I liked and got along with on the occasional times we ran into each other. Good neurologist, all-around nice person. It was a shock. I’d just seen him a week ago when we crossed paths and briefly chatted about life, the universe, and everything, before going on with our days.

We’d trained together back in the mid-90s. He was 2 years younger than I. I was in my last year of residency when he started the program. I remember being at different gatherings back then with him and his wife, a few with his then-young son, too.

And now he’s gone.

Along with the grief, you think about your own mortality. What can I be doing to hang around longer? To be better? To enjoy whatever time that I have left?

Why a mensch like him?

These are questions we all face at different times. Questions that have no answers (or at least not easy ones). There’s a lot of “why” in the universe.

There are people out there whom you don’t see often, but still consider friends, and enjoy seeing when you encounter them. Sometimes you’re bound by a common interest, or background, or who knows what. You may not think of them much, but it’s somehow reassuring to know they’re out there. And upsetting when you suddenly realize they aren’t.

You feel awful for them and their families. You wish there was a reason, or that something, anything, good will come out of the loss. But right now you don’t see any.

Our time here is never long enough. We make the best of what we have and wish for a better tomorrow.

As Longfellow wrote, the best we can hope for is to leave “footprints on the sands of time.” In medicine, and in everyday life, we strive to do our best for ourselves and for those who need us.

I’ll miss you, friend.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Early Monday morning was my usual start-the-week routine: Set up things at the office, update my computer, check the mail, review the week’s schedule.

I was rolling the phones when a text passed by on my screen that a friend had died.

He wasn’t a close friend, but still someone I liked and got along with on the occasional times we ran into each other. Good neurologist, all-around nice person. It was a shock. I’d just seen him a week ago when we crossed paths and briefly chatted about life, the universe, and everything, before going on with our days.

We’d trained together back in the mid-90s. He was 2 years younger than I. I was in my last year of residency when he started the program. I remember being at different gatherings back then with him and his wife, a few with his then-young son, too.

And now he’s gone.

Along with the grief, you think about your own mortality. What can I be doing to hang around longer? To be better? To enjoy whatever time that I have left?

Why a mensch like him?

These are questions we all face at different times. Questions that have no answers (or at least not easy ones). There’s a lot of “why” in the universe.

There are people out there whom you don’t see often, but still consider friends, and enjoy seeing when you encounter them. Sometimes you’re bound by a common interest, or background, or who knows what. You may not think of them much, but it’s somehow reassuring to know they’re out there. And upsetting when you suddenly realize they aren’t.

You feel awful for them and their families. You wish there was a reason, or that something, anything, good will come out of the loss. But right now you don’t see any.

Our time here is never long enough. We make the best of what we have and wish for a better tomorrow.

As Longfellow wrote, the best we can hope for is to leave “footprints on the sands of time.” In medicine, and in everyday life, we strive to do our best for ourselves and for those who need us.

I’ll miss you, friend.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Early Monday morning was my usual start-the-week routine: Set up things at the office, update my computer, check the mail, review the week’s schedule.

I was rolling the phones when a text passed by on my screen that a friend had died.

He wasn’t a close friend, but still someone I liked and got along with on the occasional times we ran into each other. Good neurologist, all-around nice person. It was a shock. I’d just seen him a week ago when we crossed paths and briefly chatted about life, the universe, and everything, before going on with our days.

We’d trained together back in the mid-90s. He was 2 years younger than I. I was in my last year of residency when he started the program. I remember being at different gatherings back then with him and his wife, a few with his then-young son, too.

And now he’s gone.

Along with the grief, you think about your own mortality. What can I be doing to hang around longer? To be better? To enjoy whatever time that I have left?

Why a mensch like him?

These are questions we all face at different times. Questions that have no answers (or at least not easy ones). There’s a lot of “why” in the universe.

There are people out there whom you don’t see often, but still consider friends, and enjoy seeing when you encounter them. Sometimes you’re bound by a common interest, or background, or who knows what. You may not think of them much, but it’s somehow reassuring to know they’re out there. And upsetting when you suddenly realize they aren’t.

You feel awful for them and their families. You wish there was a reason, or that something, anything, good will come out of the loss. But right now you don’t see any.

Our time here is never long enough. We make the best of what we have and wish for a better tomorrow.

As Longfellow wrote, the best we can hope for is to leave “footprints on the sands of time.” In medicine, and in everyday life, we strive to do our best for ourselves and for those who need us.

I’ll miss you, friend.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

A Miami-area nurse practitioner has been convicted of defrauding Medicare by submitting fraudulent claims for more than $200 million worth of unnecessary genetic testing and medical equipment, federal prosecutors announced.

Elizabeth Hernandez, 45, of Homestead, Fla., could face as many as 75 years in prison when she’s sentenced on December 14.

Ms. Hernandez overbilled Medicare by more than $200 million, according to prosecutors who say she ordered more cancer genetic tests for Medicare beneficiaries in 2020 than any other clinician in the nation. She “personally pocketed approximately $1.6 million in the scheme, which she used to purchase expensive cars, jewelry, home renovations, and travel,” prosecutors said.

After a 6-day trial, Ms. Hernandez was convicted last week of a single count of conspiracy to commit health care fraud and wire fraud, four counts of health care fraud and three counts of making false statements relating to health care matters. She was acquitted of two counts of health care fraud.

The case is part of an ongoing effort by federal prosecutors to target schemes alleged to have defrauded Medicare of billions of dollars in reimbursement for genetic testing and other health services.

Prosecutors alleged that Ms. Hernandez took advantage of the flexible telemedicine rules allowed during the COVID-19 pandemic, and she and another nurse “essentially robo-signed” the orders.

As part of the scheme, telemarketing companies would contact Medicare beneficiaries to convince them to request orthotic braces and genetic tests, and then send prefilled orders for these products to Ms. Hernandez, who signed them, attesting that she had examined or treated the patients, prosecutors said in a statement.

According to prosecutors, Ms. Hernandez billed Medicare as if she had performed complex in-person evaluations of patients. The time she attested she spent on these supposed office visits often accounted for more than 24 hours in a day. Prosecutors said Ms. Hernandez never examined the patients for whom she ordered $14 million in medical equipment, and that she lied when she certified that she’d personally examined them and determined the supplies were necessary.

Prosecutors also alleged that Ms. Hernandez ordered $119 million worth of unnecessary genetic tests for patients she wasn’t treating. The tests include “cancer genetic” (CGx) tests, which look for mutations that may raise the risk of certain diseases, and pharmacogenetic (PGx) tests, which can provide information about how patients will respond to medications.

According to prosecutors, Medicare only rarely covers CGx tests, doing so primarily when a patient has cancer and the patient’s physician orders such tests to improve treatment.

Ms. Hernandez also allegedly submitted claims for $1.3 million worth of telemedicine consultations that were not performed.

Prosecutors later put the total amount of fraudulent claims at more than $200 million.

Federal prosecutors also alleged that several companies that claimed to be in the telemedicine business gave bribes and kickbacks to Ms. Hernandez.

In recent years, federal officials have increasingly targeted schemes to defraud Medicare through fake claims for genetic testing. In 2020, for instance, prosecutors charged 345 defendants, including more than 100 doctors, nurses, and other licensed medical professionals, with submitting more than $6 billion in fraudulent claims for genetic testing and other services.

Last December, a Georgia man was convicted in a scheme alleged to have cost Medicare $463 million. He was accused of having “conspired with patient brokers, telemedicine companies, and call centers to target Medicare beneficiaries with telemarketing calls falsely stating that Medicare covered expensive cancer genetic tests,” according to a statement from federal prosecutors.

In a 2021 report, the inspector general of the U.S. Department of Health & Human Services warned that a sharp rise in Medicare payments for genetic tests could be a sign of fraud even as federal guidance related to coverage for genetic testing has been inconsistent. The payments quadrupled to $1.41 billion from 2016 to 2019.

A version of this article first appeared on Medscape.com.

A Miami-area nurse practitioner has been convicted of defrauding Medicare by submitting fraudulent claims for more than $200 million worth of unnecessary genetic testing and medical equipment, federal prosecutors announced.

Elizabeth Hernandez, 45, of Homestead, Fla., could face as many as 75 years in prison when she’s sentenced on December 14.

Ms. Hernandez overbilled Medicare by more than $200 million, according to prosecutors who say she ordered more cancer genetic tests for Medicare beneficiaries in 2020 than any other clinician in the nation. She “personally pocketed approximately $1.6 million in the scheme, which she used to purchase expensive cars, jewelry, home renovations, and travel,” prosecutors said.

After a 6-day trial, Ms. Hernandez was convicted last week of a single count of conspiracy to commit health care fraud and wire fraud, four counts of health care fraud and three counts of making false statements relating to health care matters. She was acquitted of two counts of health care fraud.

The case is part of an ongoing effort by federal prosecutors to target schemes alleged to have defrauded Medicare of billions of dollars in reimbursement for genetic testing and other health services.

Prosecutors alleged that Ms. Hernandez took advantage of the flexible telemedicine rules allowed during the COVID-19 pandemic, and she and another nurse “essentially robo-signed” the orders.

As part of the scheme, telemarketing companies would contact Medicare beneficiaries to convince them to request orthotic braces and genetic tests, and then send prefilled orders for these products to Ms. Hernandez, who signed them, attesting that she had examined or treated the patients, prosecutors said in a statement.

According to prosecutors, Ms. Hernandez billed Medicare as if she had performed complex in-person evaluations of patients. The time she attested she spent on these supposed office visits often accounted for more than 24 hours in a day. Prosecutors said Ms. Hernandez never examined the patients for whom she ordered $14 million in medical equipment, and that she lied when she certified that she’d personally examined them and determined the supplies were necessary.

Prosecutors also alleged that Ms. Hernandez ordered $119 million worth of unnecessary genetic tests for patients she wasn’t treating. The tests include “cancer genetic” (CGx) tests, which look for mutations that may raise the risk of certain diseases, and pharmacogenetic (PGx) tests, which can provide information about how patients will respond to medications.

According to prosecutors, Medicare only rarely covers CGx tests, doing so primarily when a patient has cancer and the patient’s physician orders such tests to improve treatment.

Ms. Hernandez also allegedly submitted claims for $1.3 million worth of telemedicine consultations that were not performed.

Prosecutors later put the total amount of fraudulent claims at more than $200 million.

Federal prosecutors also alleged that several companies that claimed to be in the telemedicine business gave bribes and kickbacks to Ms. Hernandez.

In recent years, federal officials have increasingly targeted schemes to defraud Medicare through fake claims for genetic testing. In 2020, for instance, prosecutors charged 345 defendants, including more than 100 doctors, nurses, and other licensed medical professionals, with submitting more than $6 billion in fraudulent claims for genetic testing and other services.

Last December, a Georgia man was convicted in a scheme alleged to have cost Medicare $463 million. He was accused of having “conspired with patient brokers, telemedicine companies, and call centers to target Medicare beneficiaries with telemarketing calls falsely stating that Medicare covered expensive cancer genetic tests,” according to a statement from federal prosecutors.

In a 2021 report, the inspector general of the U.S. Department of Health & Human Services warned that a sharp rise in Medicare payments for genetic tests could be a sign of fraud even as federal guidance related to coverage for genetic testing has been inconsistent. The payments quadrupled to $1.41 billion from 2016 to 2019.

A version of this article first appeared on Medscape.com.

A Miami-area nurse practitioner has been convicted of defrauding Medicare by submitting fraudulent claims for more than $200 million worth of unnecessary genetic testing and medical equipment, federal prosecutors announced.

Elizabeth Hernandez, 45, of Homestead, Fla., could face as many as 75 years in prison when she’s sentenced on December 14.

Ms. Hernandez overbilled Medicare by more than $200 million, according to prosecutors who say she ordered more cancer genetic tests for Medicare beneficiaries in 2020 than any other clinician in the nation. She “personally pocketed approximately $1.6 million in the scheme, which she used to purchase expensive cars, jewelry, home renovations, and travel,” prosecutors said.

After a 6-day trial, Ms. Hernandez was convicted last week of a single count of conspiracy to commit health care fraud and wire fraud, four counts of health care fraud and three counts of making false statements relating to health care matters. She was acquitted of two counts of health care fraud.

The case is part of an ongoing effort by federal prosecutors to target schemes alleged to have defrauded Medicare of billions of dollars in reimbursement for genetic testing and other health services.

Prosecutors alleged that Ms. Hernandez took advantage of the flexible telemedicine rules allowed during the COVID-19 pandemic, and she and another nurse “essentially robo-signed” the orders.

As part of the scheme, telemarketing companies would contact Medicare beneficiaries to convince them to request orthotic braces and genetic tests, and then send prefilled orders for these products to Ms. Hernandez, who signed them, attesting that she had examined or treated the patients, prosecutors said in a statement.

According to prosecutors, Ms. Hernandez billed Medicare as if she had performed complex in-person evaluations of patients. The time she attested she spent on these supposed office visits often accounted for more than 24 hours in a day. Prosecutors said Ms. Hernandez never examined the patients for whom she ordered $14 million in medical equipment, and that she lied when she certified that she’d personally examined them and determined the supplies were necessary.

Prosecutors also alleged that Ms. Hernandez ordered $119 million worth of unnecessary genetic tests for patients she wasn’t treating. The tests include “cancer genetic” (CGx) tests, which look for mutations that may raise the risk of certain diseases, and pharmacogenetic (PGx) tests, which can provide information about how patients will respond to medications.

According to prosecutors, Medicare only rarely covers CGx tests, doing so primarily when a patient has cancer and the patient’s physician orders such tests to improve treatment.

Ms. Hernandez also allegedly submitted claims for $1.3 million worth of telemedicine consultations that were not performed.

Prosecutors later put the total amount of fraudulent claims at more than $200 million.

Federal prosecutors also alleged that several companies that claimed to be in the telemedicine business gave bribes and kickbacks to Ms. Hernandez.

In recent years, federal officials have increasingly targeted schemes to defraud Medicare through fake claims for genetic testing. In 2020, for instance, prosecutors charged 345 defendants, including more than 100 doctors, nurses, and other licensed medical professionals, with submitting more than $6 billion in fraudulent claims for genetic testing and other services.

Last December, a Georgia man was convicted in a scheme alleged to have cost Medicare $463 million. He was accused of having “conspired with patient brokers, telemedicine companies, and call centers to target Medicare beneficiaries with telemarketing calls falsely stating that Medicare covered expensive cancer genetic tests,” according to a statement from federal prosecutors.

In a 2021 report, the inspector general of the U.S. Department of Health & Human Services warned that a sharp rise in Medicare payments for genetic tests could be a sign of fraud even as federal guidance related to coverage for genetic testing has been inconsistent. The payments quadrupled to $1.41 billion from 2016 to 2019.

A version of this article first appeared on Medscape.com.

Patients sometimes want to give back to their physician or hospital. In recent years, the practice of soliciting donations from these patients has grown into structured fundraising initiatives at some health care organizations. Some employers mandate clinicians solicit donations, while other doctors participate voluntarily.

But the nation’s second-largest physician group is cautioning its members not to ask their patients for donations to the clinician’s workplace.

“In recent decades, more physician practices have become part of large health systems: these arrangements can offer benefits to care but can also lead to interference in the patient-physician relationship and challenges to the physician’s ethical responsibilities to patients,” said Omar T. Atiq, MD, president of the American College of Physicians.

Grateful patient fundraising (GPF) is largely based on models of charitable giving outside of health care and is relatively new to the industry. Simply defined, it is the solicitation of donations by doctors from current and former patients. Funds may be used for operating costs, clinical research, equipment upgrades, or facility improvements.

In a newly published position paper, the ACP, which represents roughly 161,000 physicians, is clear that clinicians should not try to convert their patients into donors.

“Physicians who directly solicit funds from their own patients do risk interfering with the physician-patient relationship, which is supposed to be based on the patient’s best interests, not the physicians’ interests,” said Stacey A. Tovino, JD, PhD, director of health care law programs at the University of Oklahoma, Norman.

Once involved in fundraising, patients may also develop an unrealistic expectation of what kind of care they should receive, according to the ACP.

Another pitfall clinicians may fall into is the HIPAA Privacy Rule. In 2013, HIPAA was expanded to allow hospital fundraisers to access privileged health information, including demographic, health insurance, treating clinician, and data on outcomes. Dr. Atiq said that, since then, electronic health records have been used as tools to aide fundraising efforts. For instance, some health care organizations have embedded a feature inside EHRs to allow physicians to flag development officers when a patient or family member might be a potential donor. 

Patients may be unaware that hospital fundraising departments have access to their electronic health records, or that they have the right to opt out of fundraising solicitations.

“Physicians should not use or reveal patient information for fundraising,” Dr. Atiq said. “Even acknowledging that a person is under one’s care can make it possible for protected health information to be revealed.”

Data-mining EHRs may be legal, Ms. Tovino said, but it hugs a fine ethical line.

“A patient may not expect that their information will be used for these purposes and may not know how to opt out of having their information used in these ways,” Ms. Tovino said.

A clinician’s employment contract, whether it be a full-time position or for specific admitting privileges, may make it hard for them to push back against expectations to ask patients for money or screen for donors. Metrics or expectations to approach potential donors create ethical snares for clinicians – and it pits them between their patient and place of employment.

“GPF does raise ethical concerns, including those surrounding confidentiality and privacy, and whether physicians are being remunerated or evaluated based on their participation,” Ms. Tovino said.

Asked how doctors can avoid being involved in GPF, Dr. Atiq referred to the ACP ethics manual, which separates clinicians from fundraising.

“Redirecting the patient to discuss donations with institutional administrators provides the appropriate venue and firewall,” he said.

An author of the ACP paper reported a paid position on the board of the Government Employees Health Association.

A version of this article first appeared on Medscape.com.

Patients sometimes want to give back to their physician or hospital. In recent years, the practice of soliciting donations from these patients has grown into structured fundraising initiatives at some health care organizations. Some employers mandate clinicians solicit donations, while other doctors participate voluntarily.

But the nation’s second-largest physician group is cautioning its members not to ask their patients for donations to the clinician’s workplace.

“In recent decades, more physician practices have become part of large health systems: these arrangements can offer benefits to care but can also lead to interference in the patient-physician relationship and challenges to the physician’s ethical responsibilities to patients,” said Omar T. Atiq, MD, president of the American College of Physicians.

Grateful patient fundraising (GPF) is largely based on models of charitable giving outside of health care and is relatively new to the industry. Simply defined, it is the solicitation of donations by doctors from current and former patients. Funds may be used for operating costs, clinical research, equipment upgrades, or facility improvements.

In a newly published position paper, the ACP, which represents roughly 161,000 physicians, is clear that clinicians should not try to convert their patients into donors.

“Physicians who directly solicit funds from their own patients do risk interfering with the physician-patient relationship, which is supposed to be based on the patient’s best interests, not the physicians’ interests,” said Stacey A. Tovino, JD, PhD, director of health care law programs at the University of Oklahoma, Norman.

Once involved in fundraising, patients may also develop an unrealistic expectation of what kind of care they should receive, according to the ACP.

Another pitfall clinicians may fall into is the HIPAA Privacy Rule. In 2013, HIPAA was expanded to allow hospital fundraisers to access privileged health information, including demographic, health insurance, treating clinician, and data on outcomes. Dr. Atiq said that, since then, electronic health records have been used as tools to aide fundraising efforts. For instance, some health care organizations have embedded a feature inside EHRs to allow physicians to flag development officers when a patient or family member might be a potential donor. 

Patients may be unaware that hospital fundraising departments have access to their electronic health records, or that they have the right to opt out of fundraising solicitations.

“Physicians should not use or reveal patient information for fundraising,” Dr. Atiq said. “Even acknowledging that a person is under one’s care can make it possible for protected health information to be revealed.”

Data-mining EHRs may be legal, Ms. Tovino said, but it hugs a fine ethical line.

“A patient may not expect that their information will be used for these purposes and may not know how to opt out of having their information used in these ways,” Ms. Tovino said.

A clinician’s employment contract, whether it be a full-time position or for specific admitting privileges, may make it hard for them to push back against expectations to ask patients for money or screen for donors. Metrics or expectations to approach potential donors create ethical snares for clinicians – and it pits them between their patient and place of employment.

“GPF does raise ethical concerns, including those surrounding confidentiality and privacy, and whether physicians are being remunerated or evaluated based on their participation,” Ms. Tovino said.

Asked how doctors can avoid being involved in GPF, Dr. Atiq referred to the ACP ethics manual, which separates clinicians from fundraising.

“Redirecting the patient to discuss donations with institutional administrators provides the appropriate venue and firewall,” he said.

An author of the ACP paper reported a paid position on the board of the Government Employees Health Association.

A version of this article first appeared on Medscape.com.

Patients sometimes want to give back to their physician or hospital. In recent years, the practice of soliciting donations from these patients has grown into structured fundraising initiatives at some health care organizations. Some employers mandate clinicians solicit donations, while other doctors participate voluntarily.

But the nation’s second-largest physician group is cautioning its members not to ask their patients for donations to the clinician’s workplace.

“In recent decades, more physician practices have become part of large health systems: these arrangements can offer benefits to care but can also lead to interference in the patient-physician relationship and challenges to the physician’s ethical responsibilities to patients,” said Omar T. Atiq, MD, president of the American College of Physicians.

Grateful patient fundraising (GPF) is largely based on models of charitable giving outside of health care and is relatively new to the industry. Simply defined, it is the solicitation of donations by doctors from current and former patients. Funds may be used for operating costs, clinical research, equipment upgrades, or facility improvements.

In a newly published position paper, the ACP, which represents roughly 161,000 physicians, is clear that clinicians should not try to convert their patients into donors.

“Physicians who directly solicit funds from their own patients do risk interfering with the physician-patient relationship, which is supposed to be based on the patient’s best interests, not the physicians’ interests,” said Stacey A. Tovino, JD, PhD, director of health care law programs at the University of Oklahoma, Norman.

Once involved in fundraising, patients may also develop an unrealistic expectation of what kind of care they should receive, according to the ACP.

Another pitfall clinicians may fall into is the HIPAA Privacy Rule. In 2013, HIPAA was expanded to allow hospital fundraisers to access privileged health information, including demographic, health insurance, treating clinician, and data on outcomes. Dr. Atiq said that, since then, electronic health records have been used as tools to aide fundraising efforts. For instance, some health care organizations have embedded a feature inside EHRs to allow physicians to flag development officers when a patient or family member might be a potential donor. 

Patients may be unaware that hospital fundraising departments have access to their electronic health records, or that they have the right to opt out of fundraising solicitations.

“Physicians should not use or reveal patient information for fundraising,” Dr. Atiq said. “Even acknowledging that a person is under one’s care can make it possible for protected health information to be revealed.”

Data-mining EHRs may be legal, Ms. Tovino said, but it hugs a fine ethical line.

“A patient may not expect that their information will be used for these purposes and may not know how to opt out of having their information used in these ways,” Ms. Tovino said.

A clinician’s employment contract, whether it be a full-time position or for specific admitting privileges, may make it hard for them to push back against expectations to ask patients for money or screen for donors. Metrics or expectations to approach potential donors create ethical snares for clinicians – and it pits them between their patient and place of employment.

“GPF does raise ethical concerns, including those surrounding confidentiality and privacy, and whether physicians are being remunerated or evaluated based on their participation,” Ms. Tovino said.

Asked how doctors can avoid being involved in GPF, Dr. Atiq referred to the ACP ethics manual, which separates clinicians from fundraising.

“Redirecting the patient to discuss donations with institutional administrators provides the appropriate venue and firewall,” he said.

An author of the ACP paper reported a paid position on the board of the Government Employees Health Association.

A version of this article first appeared on Medscape.com.

TOPLINE:

A minority of Black dermatologists hold leadership positions in academia.

METHODOLOGY:

• To assess the prevalence of Black dermatologists in academic dermatology programs, researchers obtained an inventory of all 142 U.S.-accredited dermatology residency programs from the Accreditation Council for Graduate Medical Education.
• The researchers drew from institutional websites, the Black Derm Directory (an online repository of Black dermatologists), and other sources to identify full- and part-time Black faculty.
• Variables of interest for each Black dermatologist included gender, institution, department title, academic and nonacademic leadership roles, publication number, National Institutes of Health grant funding, degrees, subspecialties, medical school attended, place of residency, and fellowship training.
• The researchers used Pearson’s chi-squared testing to calculate associations.

TAKEAWAY:

• Of the 86 Black faculty identified, 81.4% were female; most (42.4%) were in the southern United States, followed by the Midwest (23.5%); and 83% held full-time positions.
• Slightly more than one-quarter (26.7%) of the Black faculty attended a top 10 medical school, 16.3% graduated from a historically Black college and university medical school, and 43.5% of those with 25 or more research publications had attended a top 10 medical school.
• Only three dermatology department chairs were Black, and all were female. In addition, more than half of Black faculty (59.2%) were assistant professors, 37.7% held leadership positions at their institutions, and 32.6% held outside leadership roles in dermatology (such as leadership titles at professional dermatology organizations or editorial positions at a journal).

IN PRACTICE:

“Greater efforts are needed to recruit Black dermatology graduates into academic faculty positions,” and “faculty development programs offered by academic institutions and dermatologic associations ... should continue to be expanded,” the authors conclude.

SOURCE:

Corresponding author Nada Elbuluk, MD, MSc, director of the skin of color and pigmentary disorders program and the diversity and inclusion program in the department of dermatology at the University of Southern California, Los Angeles, led the research. The study was published in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The process for identifying Black faculty and insufficient or outdated information on department websites were limitations.

DISCLOSURES:

Dr. Elbuluk disclosed that she has served as a consultant for Avita, Scientis, Incyte, VisualDx, La Roche Posay, Beiersdorf, and Unilever. She has served on advisory boards for Allergan, Eli Lilly, Galderma, Incyte, Pfizer, Janssen, La Roche Posay, L’Oreal, McGraw Hill, and Dior. She has been a speaker for La Roche Posay, Scientis, Medscape, Beiersdorf, and Dior, and has served as investigator for Avita. Another author is an investigator and speaker for Castle Biosciences.

A version of this article first appeared on Medscape.com.

TOPLINE:

A minority of Black dermatologists hold leadership positions in academia.

METHODOLOGY:

• To assess the prevalence of Black dermatologists in academic dermatology programs, researchers obtained an inventory of all 142 U.S.-accredited dermatology residency programs from the Accreditation Council for Graduate Medical Education.
• The researchers drew from institutional websites, the Black Derm Directory (an online repository of Black dermatologists), and other sources to identify full- and part-time Black faculty.
• Variables of interest for each Black dermatologist included gender, institution, department title, academic and nonacademic leadership roles, publication number, National Institutes of Health grant funding, degrees, subspecialties, medical school attended, place of residency, and fellowship training.
• The researchers used Pearson’s chi-squared testing to calculate associations.

TAKEAWAY:

• Of the 86 Black faculty identified, 81.4% were female; most (42.4%) were in the southern United States, followed by the Midwest (23.5%); and 83% held full-time positions.
• Slightly more than one-quarter (26.7%) of the Black faculty attended a top 10 medical school, 16.3% graduated from a historically Black college and university medical school, and 43.5% of those with 25 or more research publications had attended a top 10 medical school.
• Only three dermatology department chairs were Black, and all were female. In addition, more than half of Black faculty (59.2%) were assistant professors, 37.7% held leadership positions at their institutions, and 32.6% held outside leadership roles in dermatology (such as leadership titles at professional dermatology organizations or editorial positions at a journal).

IN PRACTICE:

“Greater efforts are needed to recruit Black dermatology graduates into academic faculty positions,” and “faculty development programs offered by academic institutions and dermatologic associations ... should continue to be expanded,” the authors conclude.

SOURCE:

Corresponding author Nada Elbuluk, MD, MSc, director of the skin of color and pigmentary disorders program and the diversity and inclusion program in the department of dermatology at the University of Southern California, Los Angeles, led the research. The study was published in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The process for identifying Black faculty and insufficient or outdated information on department websites were limitations.

DISCLOSURES:

Dr. Elbuluk disclosed that she has served as a consultant for Avita, Scientis, Incyte, VisualDx, La Roche Posay, Beiersdorf, and Unilever. She has served on advisory boards for Allergan, Eli Lilly, Galderma, Incyte, Pfizer, Janssen, La Roche Posay, L’Oreal, McGraw Hill, and Dior. She has been a speaker for La Roche Posay, Scientis, Medscape, Beiersdorf, and Dior, and has served as investigator for Avita. Another author is an investigator and speaker for Castle Biosciences.

A version of this article first appeared on Medscape.com.

TOPLINE:

A minority of Black dermatologists hold leadership positions in academia.

METHODOLOGY:

• To assess the prevalence of Black dermatologists in academic dermatology programs, researchers obtained an inventory of all 142 U.S.-accredited dermatology residency programs from the Accreditation Council for Graduate Medical Education.
• The researchers drew from institutional websites, the Black Derm Directory (an online repository of Black dermatologists), and other sources to identify full- and part-time Black faculty.
• Variables of interest for each Black dermatologist included gender, institution, department title, academic and nonacademic leadership roles, publication number, National Institutes of Health grant funding, degrees, subspecialties, medical school attended, place of residency, and fellowship training.
• The researchers used Pearson’s chi-squared testing to calculate associations.

TAKEAWAY:

• Of the 86 Black faculty identified, 81.4% were female; most (42.4%) were in the southern United States, followed by the Midwest (23.5%); and 83% held full-time positions.
• Slightly more than one-quarter (26.7%) of the Black faculty attended a top 10 medical school, 16.3% graduated from a historically Black college and university medical school, and 43.5% of those with 25 or more research publications had attended a top 10 medical school.
• Only three dermatology department chairs were Black, and all were female. In addition, more than half of Black faculty (59.2%) were assistant professors, 37.7% held leadership positions at their institutions, and 32.6% held outside leadership roles in dermatology (such as leadership titles at professional dermatology organizations or editorial positions at a journal).

IN PRACTICE:

“Greater efforts are needed to recruit Black dermatology graduates into academic faculty positions,” and “faculty development programs offered by academic institutions and dermatologic associations ... should continue to be expanded,” the authors conclude.

SOURCE:

Corresponding author Nada Elbuluk, MD, MSc, director of the skin of color and pigmentary disorders program and the diversity and inclusion program in the department of dermatology at the University of Southern California, Los Angeles, led the research. The study was published in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The process for identifying Black faculty and insufficient or outdated information on department websites were limitations.

DISCLOSURES:

Dr. Elbuluk disclosed that she has served as a consultant for Avita, Scientis, Incyte, VisualDx, La Roche Posay, Beiersdorf, and Unilever. She has served on advisory boards for Allergan, Eli Lilly, Galderma, Incyte, Pfizer, Janssen, La Roche Posay, L’Oreal, McGraw Hill, and Dior. She has been a speaker for La Roche Posay, Scientis, Medscape, Beiersdorf, and Dior, and has served as investigator for Avita. Another author is an investigator and speaker for Castle Biosciences.

A version of this article first appeared on Medscape.com.