Journal of Dermatology for Physician Assistants

The official journal of the Society of Dermatology Physician Assistants

Expert Advice

By Alan Rockoff, MD

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 fifteen bucks, you could access the Medical Forum and ask a doctor. For ten, you could join the Community Forum and ask anybody with an opinion. One guess about which forum was more popular.

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 asked.

“Should we let nature take its course with them?”

He thought for a moment and said, “If you don’t get vaccinated, can I get really sick, or is it just like the flu?”
“Yes, you can get really sick,” I said, “even if you’re not old or don’t have a weak immune system.”
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 glare, or worse. Very few people like to be singled out and pointed at.

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 lot, 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. But 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.

Alan Rockoff, MD, practices dermatology in Boston, Massachusetts. He graduated with his medical degree in 1972 from the Albert Einstein College of Medicine in Bronx, New York and then completed a pediatric internship and residency at Bronx Municipal Hospital Center in Bronx, New York. Continuing his education, Dr. Rockoff completed a dermatology residency program at the combined program at Boston University and Tufts University in Boston, Massachusetts.

Dr. Rockoff is a Clinical Assistant Professor of Dermatology at Tufts University School of Medicine. He has taught senior medical students and other trainees for more than 35 years. Dr. Rockoff has been named one of Boston’s Top Doctors by Boston Magazine for five years. Dr. Rockoff is board certified by the American Board of Pediatrics and the American Board of Dermatology. Dr. Rockoff is a Fellow of the American Academy of Dermatology and a member of the Massachusetts Medical Society and the Massachusetts Academy of Dermatology.

Dr. Rockoff’s publications have appeared in numerous journals. He writes a monthly column for his dermatologic colleagues in Dermatology News as well as a blog for the magazine Psychology Today. His first book, “Under My Skin: A Dermatologist Looks at His Profession and His Patients” is available on Amazon and is his second book, “Act Like a Doctor, Think Like a Patient: Teaching Patient-focused Medicine” is available on Amazon and at Barnes and Noble. His third and most recent book, “Doctoring from the Outside in: Dermatology under the Skin” is available on Amazon in paperback and Kindle format.

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