29th National conference of Indian association of dermatologists, venereologists & leprologists

Bhushan Kumar

 Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India

Correspondence Address:
Bhushan Kumar
Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh
India

Hon. Chief Minister of UP Sh. Rajnath Singh, dignitaries on the dais, galaxy of international and na-tional guests, fellow delegates, Ladies and Gentlemen.

It is with a sense of humility and great responsibility that I stand here to address this gathering of derma-tologists from all over the country and abroad. I can see my revered teachers, old colleagues, young and energetic students and many friends amongst you. No words can suffice to express my sincere and overwhelm-ing gratitude to all of you for inspiring me and supporting me in my efforts to serve our Association. I am looking forward to working with the new team of representatives, most of who are already experienced in the affairs of the IADVL. It is a privilege for me to be given an opportunity to work with them for and on behalf of all my fellow dermatologists and a responsibility of which I hope I will prove worthy.

As we adapt to our changing role from mere healers of skin ailments to active interventionists in charge of the overall external appearances of our patients, our task is becoming increasingly complex. Legal and ethical issues confront us in our day-to-day interactions with patients and our peers as never before. Gone are the days when patients considered us beyond reproach and doctors never criticised colleagues. The stress of working in such an environment can sometimes impinge even upon our interpersonal relationship. In these turbulent times of change when the doctor-patient relationship is increasingly becoming akin to client-service provider relationship, we need to remember the medical litany of Sir Robert Hutchison:

From inability to leave alone;

From too much zeal for what is new and contempt for what is new and contempt for what is old

From putting knowledgebe before wisdom, science befoce art, cleverness before common sense;

Gooa Lord, deliver us.

We have to keep these golden words in mind every time we hear of or use a new machine or a so-called ′latest′ treatment. Only with a judicious mix of experience and solid evidence-based information can we fully justify the faith placed in us by our patients. In performing cosmetics procedures like chemical peels or facial resurfacing, we need to apprize the patients of the expected efficacy and possible side effects of the inter-vention. Litigations can frequently arise from dissatisfied patients who had sky-high expectations before the procedure. In such cases, potential ethical and disciplinary issues may be raised with risk of terminations of one′s career. Therefore, we need to evolve standard consent forms for surgery and phototherapy which are ethically and legally sound. Therefore I propose that this year we may also formulate a standard consent form in consultation with medico-legal experts to protect our members from the consumer courts.

In trying to maintain the highest standards of practice, it is emplicit that the quality of training imparted to budding dermatologists should be of a correspondingly high order. Unfortunately with the rapid mushrooming of medical colleges, that is becoming increasingly difficult to ensure. I am sure we are well aware of the superficial and cursory treatment given to the teaching of dermatology during undergraduate training. Ironically the new MBBS syllabus, recently approved by the Medical Council of India has made internship training in dermatology, sexually transmitted diseases and leprosy as optional. With such grounding, how can we expect to attract talented students into our stream? Moreover, the same lack of standardization continues to plague postgraduate studies in various colleges. There is an urgent need to establish uniform and strictly enforceable norms of undergraduate and postgraduate training allover the country. Only then can we raise the quality of care and thereby the profile of dermatologists as thorough and competent professionals. Teaching hospitals should take the lead in this direction by increasing fellowship and observership courses. Presently, course in photo- therapy, dermatosurgery and other disciplines are being run or planned by some institutes, including PGIMER Chandigarh, but the number is still too small.

No other branch of Medicine has to deal with as many wrong beliefs and prejudices as ours. It is incumbent upon us to increase public awareness with campaigns, publicity and patient education. Pamphlets on common skin conditions, detailing the expected course, possible treatment options and mode of trans-mission can go a long way towards allaying the fears of patients and their relatives and friends. Even an extra minute spent talking to the patient can serve this purpose well. Patient information is absolutely crucial for the dermatoses of modernisation namely contact dermatitis and other occupational dermatoses. Perhaps the most desperate need for education and community sensitisation is in the field of HIV and other sexually transmitted infections. Till this aspect of the problem is targeted, we will not be able to achieve the cornerstone of STI control-behaviour modification. We have to put out this information in all hospitals and clinics in the form of pamphlets and posters and at the national level by means of a dedicated web page. Community awareness also needs to be increased in the field of leprosy and enough stress has to be laid on the medical and socio-psychological aspects of this ancient disease which continues to plague our country. The goal of leprosy elimination has already been pushed further ahead than planned. Only if we redouble our efforts to target the worst affected areas-which ironically are the areas where control measures are least efficient-can we ensure that this target is not pushed any further.

The Indian Association of Dermatologists, Venereologists & Leprologists is a healthy and vital or-ganization. In such a setting, debate and dissent are healthy and indeed welcome signs of vigor. We must encourage discussion and new ideas within fora such as this Annual Conference. At the same time, it behooves us to keep away from personal references and make sure that inter-personal relationship is not soured by professional disagreements. We also need to be more outward looking and interactive by developing an un-derstanding with other Associations in foreign countries so that some of our colleagues can be allowed to attend their conferences on a complimentary basis.

Many young colleagues have pointed out to me that DM courses in clinical immunology are not open to dermatologists. As we delve deeper into the pathogenesis of different skin ailments, time and again we are confronted with some disregulation of the immune system. Such diverse conditions as blistering disorders, papulosquamous disorders and skin manife-stations of HIV infection to everyday conditions like chronic urticaria are linked by the common thread of immunology. With such a background, it is not unlikely that some of us develop a special interest in immunology and want to pursue it more formally. I will try to convince the MCI to allow our postgraduates to have this option, as it can only increase the pool of knowledge and research in our speciality.

It is my firm opinion that the internet is an invaluable tool to help us tap the wealth of talent we have in our midst. We need to move further than just online clinical photograph atlases and physician directories. We have an excellent opportunity of building a database of clinical research which is easily accessible to a very large number of our colleagues and patients. I am happy to know that a few such interactive special interest groups have already started operations on the internet. In this regard, I would like to see the establishment of an interactive website of IADVL where all members can air their views, seek the advice and help of their peers and add their knowledge and experience to the general pool. It can also act as a repository of data on Indian patients, something that we sorely lack now. This will ensure that the maximum number of patients can benefit in the least possible time. It will also make the participation of members in the running and working of their Association more direct and give them a feeling of belonging. I hope that this vision will see the light of day sooner rather than later, since the younger generation of dermatologists already has more than sufficient know--how of this new medium to make it a reality. It is on them, our younger colleagues that the future of our Association rests and I hope they will take IADVL to greater heights of glory in the years to come.

In the end, I would like to welcome you all to this beautiful and historic city of Agra and hope that the wonderful academic and cultural fare laid out by Dr. Dhir and his dedicated team will make this an unforget-table experience.

Long Live IADVL

Jai Hind

February 1, 2001