NOVEMBER 2017
Dr. Lim, you are a world-renowned dermatologist and a respected member of the medical community. What was your reason for attending medical school? Can you please share with us what motivated you to become a physician?
When I was growing up, I developed an avid interest towards science, and found great fulfillment in helping others. Thus, despite there being no physicians amongst my immediate family members, a profession in the medical field seemed to be something that I would truly enjoy and feel gratified in. I grew up in Indonesia, but moved to Canada for college, and subsequently applied for and attended medical school in the U.S.; that encapsulates why and exactly how I became involved in the field of medicine. In terms of specifically dermatology, that was actually by chance. Throughout my time in medical school, I was initially looking to become a pediatrician and this thought was largely influenced by the fact that my first year clinical mentor was a pediatrician. I truly did enjoy working with children and adolescents, and believed it to be a specialty I would like to pursue myself. Towards the end of medical school, however, which was my fourth year, I deduced as a prospective pediatrician, I would need to know more on dermatology as clearly in kids, you see a lot of rashes.
At that time, I was in New York and NYU was reputably known to have a very good dermatology program, which ultimately led me to complete a clinical elective during my fourth year of medical school at NYU. From my time there, I was very much impressed with how dermatology was taught and practiced, and made me seriously consider dermatology as a specialty I would work towards in lieu of pediatrics. The subject matter was intellectually stimulating, and dermatology, I discovered, was a field I found immense satisfaction in. So with that, after applying for a pediatric internship at various hospitals, I decided to also submit an application to the dermatology program at NYU, and only at NYU. I had received an acceptance from pediatric hospital, but when I was also notified of my acceptance into NYU’s dermatology program, I became sure that dermatology is what I sought to pursue.
“The subject matter was intellectually stimulating, and dermatology, I discovered, was a field I found immense satisfaction in.”
As a successful dermatologist with nearly 40 years of experience, you may have gone through various obstacles; can you share some of the most difficult moments in your career?
No doubt, I have truly enjoyed my career thus far in dermatology. However, likely the most difficult decision I had to make occurred towards the end of my residency at NYU in dermatology, and that was whether to go into private practice or to instead further pursue my academic career. At the time, which was in 1978 or 1979 or so, private practice was a very popular path to follow for many graduating residents, although it no longer is today due to administrative burdens. One prevailing reason for this was the income difference between a profession in private practice and an academic career in dermatology. Having had a young family with two kids at the time made this decision all the more arduous, as supporting them was an obvious consideration I had to make. However, I truly thrived in an academic setting, as I was constantly intellectually stimulated and challenged. Furthermore, I was fortunate to have two mentors who helped me in making the decision, which was to ultimately remain in academic dermatology. This was a very difficult moment, but in retrospect, I’m confident to say that it was also the most correct and probably the best decision I have made, as it has led me to a still ever so stimulating and fulfilling career in dermatology for nearly 40 years now.
Dr. Lim, you have previously been a professor of Dermatology at NYU school of Medicine and today, you are a professor at Wayne State University as well as a Senior Vice President for Academic Affairs at Henry Ford Health System. How do you view yourself as an educator? What are your principles or philosophies as a teacher?
This is namely one of the aspects in which I take tremendous enjoyment and gratification in. Having been an educator, and having mentored and interacted with younger students or faculty members meant witnessing them grow professionally. In fact, there are a number of faculty members in our department today whom I first met and knew as medical students, as well as several others in other respective departments all over the country whom I’ve also had the great experience of mentoring in the past. I take a lot of gratification in that – knowing that I have contributed not only to their growth as a clinician, educator, or researcher, but also that I have made my contribution in giving back to the specialty. As an educator and as someone who’s been in this specialty for nearly four decades, the one philosophy I prescribe to myself and others is to always a find a way to give back to the field. The younger individuals just entering the field are the very people who will be contributing and shaping dermatology in pending years. After all, the young people will become the clinicians and the academics in dermatology who continue to propel our specialty forward, as well as those who provide the best care and service to our patients.
Do you have any words of advice for those who are pursuing to be a physician?
What I wish to impart to all those seeking to become future physicians is firstly, to know that medicine still is a very noble profession. Medicine remains one of few, if not the only profession that endows you various options of continuing to pursue your career, be it in full-time practice or academic medicine, conducting research, becoming an educator and mentor for medical students and residents, or if you feel inclined, managing administrative leadership activity. All in all, it is truly a wonderful profession, as you simultaneously also develop the core with your patients by getting to know them as individuals as well as getting to know their family. This leads me to a second piece of advice: to work hard, but to also truly appreciate and take satisfaction in interacting with the patients, and to thereby give back to the profession.
You have become the president of American Academy of Dermatology. What are your key roles, responsibilities, and principles of leading the world’s largest dermatologic society that represents more than 18,000 physicians? Can you also share your visions and goals as the president of this organization.
It is truly a great honor and privilege to have been elected as President, especially since this was a position elected by the entire membership. Now, there are two major responsibilities we uphold ourselves to at the Academy.
The first is education. As the American Academy of Dermatology, we pride ourselves as a professional organization that continues to provide top quality, and what I believe to be the best medical education for dermatology across the globe. While our members remain the largest demographic, we are noting that our international audiences are increasingly attending the summer and annual meetings, which are what I would describe as the two biggest meetings we host here. In fact, the growth of our international membership has been exponential as of recent years, and it is within our objectives that we continue to evaluate, improve, and utilize many of our resources to better our education system in the AAD.
The second responsibility entails ensuring health and stability in our members. We are well aware of how demanding the practice of medicine can be nowadays, namely due to the administrative burden. As a matter of fact, that is one of the leading causes of physician burnout. Although dermatology is stated to have a lower rate of burnout amongst all other specialties, it truly depends on the individual physician. Therefore, the AAD has made it an ongoing mission to ease such administrative burdens for our members. Particularly, prior authorization tends to be the most strenuous for the members, and in order to combat this hitch, we are currently developing a website to assist our physicians with the especially laborious process. Moreover, we continue to work with legislators as well as the payers in making sure that these administrative duties do not render the actual practice of medicine as onerous for the physicians, including our members.
As for my vision in regards to the Academy, there are two goals I hope to accomplish with the members at the AAD.
We stand as a professional organization for all dermatologists, primarily in the U.S., as it is a great imperative for the AAD to advocate for this specialty and our members. One principal goal, I believe, is to encourage our members to be active participants in the activities of the house of medicine, be it in the American Medical Association or at the State Medical Societies. This way, our voice in dermatology continues to be heard and this way, we are able to continuously make positive contributions on the healthcare discourse, in the local, city, state, or national level.
Secondly, it is our earnest intent to provide an apt environment and to generally support the increase in diversity in dermatology. Specifically, we seek to increase the percentage of what we call underrepresented minority (URM), which by definition includes groups of ethnic racial groups where the proportion in medicine is less than the proportion of the general population, namely African-Americans and Hispanics. The URM percentage in dermatology, particularly, is quite low, as it is in a number of other areas and specialties in medicine. Hence, it is within our top priorities to address this disproportionate representation, and to ultimately help rectify it. However, I find it critical to mention that this is a challenge that goes beyond our capabilities at the AAD, as it is indubitably more of a pipeline issue. We, as a society, first have to increase the qualified pool of high school and medical school students in order to join dermatology, or other medical specialties.
You have conducted hundreds of research and served as an editor or co-editor in multiple textbooks. As an eminent opinion leader in dermatology, what are some major changes or trends happening in dermatology currently? Also, what do you forecast the major changes would be in dermatology in the next five years?
It is truly an exciting era in dermatology now. As aforementioned, having been in the field for approximately four decades now, I’ve personally witnessed the science of dermatology mature and advance over the years. Even so today, our understanding of dermatology continues to improve and become more sophisticated. Due to this evolution in the study of dermatology, for example, we are now able to apprehend the mechanism of the molecular pathway of the development of skin cancer, as well as the molecular pathway of development of vitiligo, which is a condition where one loses pigment in the epidermis, resulting in the development of white patches on the skin. These cases are exemplary of the idea that simply understanding the pathway itself, as in identifying what is effective and what is abnormal, can manifest in better treatment.
The most exciting aspect of this is that all of this is still ongoing, and that current changes are reflective of changes that I look forward to in coming years. Within the next five years, I expect further advancements in the findings and drug developments for various skin disorders, some of which especially include treatments for psoriasis, as well as dermatitis and eczema.
We have learned that you also specialize in sun damage and photosensitivity. Recently, there have been many public issues regarding sunscreen ingredients as well as skincare products. Do you have any concerns regarding this issue or any advice you would like to share with our readers?
The issue regarding the ingredients in sunblock and now skincare products reemerges every spring, from what I’ve observed. There is no doubt that there are positive effects in being outdoors, whether that is the benefits in physical activity or receiving a dose of sun-derived vitamin D. Yet, we’re also very much aware as a society that the sun’s ray can result in sunburn and the tanning of the skin. It also causes what we call photo-aging, which is essentially the development of wrinkles and possibly skin cancer. What we prescribe as the AAD is that maximum protection should begin with measures that go beyond sunscreen application.
However, this is not to say that individuals shouldn’t participate in outdoor activities. We simply advocate for proper protection. Returning to sunscreens, they are no doubt a proven and very effective means in shielding exposed skin, and while the concern regarding the various ingredients in sunscreen is valid, the scientific data behind the substances that receive negative press are, in truth, unsubstantial. So in conclusion, my response to concerned patients is that what’s most important is protection, and that ultimately boils down to applying sunscreen onto exposed areas.
I’ve also received inquiries and concerns regarding the “chemical ingredients” in some brands of sunscreen. Such ingredients are also known as “organic filters” in dermatology, where the ingredients sink into the skin and function as agents that absorb the harmful rays. On the other hand, there are inorganic filters, including zinc oxide and titanium dioxide that simply sit on top of the skin and reflect the rays as opposed to absorbing them. Sunscreens containing one or both of these latter ingredients are inert agents that do not lead to any other issues. Therefore, I often recommend such products to the patients who are tentative of using organic filters. However, there is a challenge in using those sunscreens, as they often leave a white sheen. Consequently some patients dislike such sunblock products for cosmetic reasons. Nonetheless, the benefits of using sunscreen as part of protection still significantly outweighs all other concerns one may have.
WKMJ has readers from over 10 countries globally. Please share your final words with our readers?
What I would like to impart as my final thoughts include one, as I’ve mentioned earlier, that I view medicine as a very noble profession, where physicians can not only further the current understanding of the mechanisms and treatments for various diseases, but also, and most importantly, help the patients. This is what gives me the greatest satisfaction. Secondly, I am incredibly grateful to have interacted with and mentored younger generations within the medical field, as teaching such individuals has been an enlightening and a truly gratifying experience for myself. I strongly and truly encourage other experienced physicians to offer their time and knowledge towards educating the medical students and residents just entering their specialty, or the overall field. Lastly, I would like to convey to all the WKMJ readers that today is truly an exciting time in medicine, as there is an incredible amount of new information acquired from research, and that with such new knowledge, there is much to be expected in new and improved treatments for various disorders and conditions, and therefore a greater welfare for our patients.
Henry W. Lim, MD, FAAD
President, American Academy of Dermatology Chair Emeritus, Department of Dermatology, Henry Ford Hospital
Terry Kim, MD, is Professor of Ophthalmology at Duke University School of Medicine and serves as Chief of the Cornea and External Disease Division and Director of the Refractive Surgery Service at Duke University Eye Center. Dr. Kim’s clinical and surgical expertise has resulted in continual annual listings by Best Doctors in Terry Kim, MD Vice President and President-Elect, American Society of Cataract and Refractive Surgery (ASCRS) Professor of Ophthalmology, Chief of the Cornea and External Disease Service at Duke University Eye Center America®, Best Doctors in North Carolina®, and America’s Top Ophthalmologists© since 2003 as well as featured stories on the Discovery Channel and The Wall Street Journal. Dr. Kim’s academic accomplishments include over 300 peer-reviewed journal articles, textbook chapters, and scientific abstracts as well as 4 well-respected textbooks on corneal diseases, corneal transplantation, and cataract surgery. His clinical and research work has earned him honors and grants from the AAO, ASCRS, National Institutes of Health, the Fight for Sight/Research to Prevent Blindness Foundation, and the Heed Ophthalmic Foundation. Dr. Kim serves on the Executive Committee of ASCRS, the Annual Program Committee of the AAO, and the Board of Directors of the Cornea Society. He also sits on the Editorial Board for several peer-reviewed journals and trade publications, including Cornea, Journal of Cataract and Refractive Surgery, Ocular Surgery News, Eyeworld, Cataract & Refractive Surgery Today. Dr. Kim serves as Consultant to the Ophthalmic Devices Panel of the FDA, Consultant Ophthalmologist for the Duke Men’s Basketball Team, and Consultant to numerous ophthalmic companies.