Pruritus Emeritus

Expert advice


 

I once answered online skin questions. The most popular one was, “Is my penis supposed to look like that?”

Then the site was bought by an entrepreneur with a corporate sensibility. He opened two forums: for 15 bucks, you could access the Medical Forum and ask a doctor. For 10, you could join the Community Forum and ask anybody with an opinion. One guess about which forum was more popular.

Cover of Dr. Alan Rockoff's latest book, "Doctoring from the Outside In."

Cover of Dr. Alan Rockoff's latest book, Doctoring from the Outside In.

Years later, a colleague referred a fellow who had run a poison ivy website for a decade and wanted to interview a doctor. He had never spoken with one before, “because it never occurred to me.” His site featured the usual folklore: that blister fluid spreads the poison, that you can catch it from your dog. His website had many pictures. Some were in focus, and a few actually showed poison ivy.

I checked a year later and found that he had never uploaded our interview to his website. When I emailed to ask how come, he said he’d been busy, and did I want him to? I told him I was OK.

What made me think of these old episodes was a phone chat I had the other day with an IT guy about my laptop.

After I told him my problem, he said, “Since you’re a doctor, could I ask you a medical question?”

“Sure.”

“Is the COVID vaccine safe?” he asked.

“I had two shots myself,” I said, “and I’m planning a third. Does that tell you what I think about how safe it is?”

He didn’t answer, and we got back to the laptop.

Five minutes later he said, “I just wonder whether we should mess with vaccines. Maybe we should let nature take its course.”

“How about polio and diphtheria?” I said. “Should we let nature take its course with them?”

He thought for a moment and said, “If you don’t get vaccinated, can you spread the virus to other people?”

“Yes, you can,” I said. “It’s not just that you can get sick, but you can make other people sick, and possibly die if they’re old or vulnerable.”

Again, no response. We finished up with the laptop.

“Thanks for your medical advice,” he said. “I get conflicting information from so many sources.”

Yes, he does. He and everybody else always have. When the issues are poison ivy and genital blotchiness, the stakes are not high enough for anyone to talk about. To a large extent, people have always made their minds up about things based on what their friends think and tell them.

If your friends all wear masks, they will stare at you if you don’t. If your friends don’t wear masks, they will stare at you if you do. Or more than that. Very few people like to be stared at. Or worse.

Dr. Alan Rockoff, now semiretired, after 40 years of practice in Brookline, Mass. He served on the clinical faculty at Tufts University, Boston, and taught senior medical students and other trainees for 30 years.

Dr. Alan Rockoff

When an issue is public and the medical stakes high, as they are with masking and COVID vaccination, lay spokesmen and sage commentators give “reasons” for one opinion or another: social media disinformation, distrust of the establishment, personal freedom. When the stakes are low, no reasons are needed. Who cares why someone blames Fido for his poison ivy?

Addressing the reasons people give for their positions, or the reasons others assign to them, may sometimes help people reconsider. For all those other times, the old adage applies: You cannot reason someone out of what he never reasoned himself into.

When it comes to contact dermatitis or penile blotches, you can try to straighten people out, but it doesn’t matter much if you fail. When the people you are trying to convince are spreading disease, filling up ICUs, or dying, it matters a great deal, which does not necessarily increase your odds of succeeding.

There have always been “Medical Forums” – where you ask a professional with official credentials – and “Community Forums” – where you ask Jerry next door or Hortense on Instagram. There always will be. Most of the time this is a curiosity of little general interest. Though not always.

Of course I believe in expert advice. I spent my whole career dispensing it.

Still, modesty is proper. Knowledge may be evolving and tentative, and sensible advice often ignored.

As Hippocrates said a long time ago: Life is short, and art long, opportunity fleeting, experimentation perilous, and judgment difficult.

They all still are.

Dr. Rockoff, who wrote the Dermatology News column “Under My Skin,” is now retired, after more than 40 years of practice in Brookline, Mass. He served on the clinical faculty at Tufts University, Boston, and taught senior medical students and other trainees for 30 years. His latest book, “Doctoring from the Outside In,” was recently published. This is his last column for Dermatology News. Write to him at [email protected].

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