In this episode of Under Your Skin, Dr Nick Brownstone chats with Dr Neal Bhatia about giving advice to a first-year dermatology resident, innovations in dermatology, and advice on communicating a serious diagnosis to a patient.

If you could go back in time, what advice would you give yourself as a first-year dermatology resident?

Dr Bhatia explains that he would discuss expectations and emphasize that a first job may not be a last job.

He would also advise a first-year dermatology resident to create a niche for themselves. They should aim to learn about everything but also create a specialty and stay in a niche that they can be proud of and dig into deeply.

Dr Bhatia also acknowledges that academic demands are high in residency; he would advise a first-year resident to try to find a balance while keeping their foot on the gas and off the brake.

What innovations in dermatology are you most excited about?

Over the course of his career, Dr Bhatia has enjoyed watching innovations develop around Janus kinase inhibitors, biologics, and strategies and options to manage itch.

He recalls being groomed on topical steroids and innovations focused on active ingredients, but comments that now, the vehicles of the topicals are getting attention. He also praises the approach of thinking about the process of disease.

Dr Bhatia also encourages dermatologists to put patients’ interests forward, get out from their own shadow, and learn to be aggressive again.

How do you communicate a serious diagnosis to your patients?

Dr Bhatia emphasizes the importance of communicating serious diagnoses in person. He encourages physical touch and eye contact when discussing the severity of a diagnosis. He advises against relaying a serious diagnosis over the phone, since patients in that scenario may not absorb any information besides the negative news and may begin doing research on their own; he encourages dermatologists to be prepared on how to talk to patients about what’s ahead and the management plan for their diagnosis.

He reiterates that putting your hands on patients is vital; he refers to dermatology as 3D and emphasizes the importance of being present with your patients. He has advised residents that they shouldn’t leave the exam room without some physical touch with their patients, even if that means just shaking hands.

Dr Bhatia comments that delivering bad news is part of being present with patients and that it’s important to relate that you’re not just delivering the bad news, you are part of the solution as well.