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“At that point, I realized Thanksgiving came early this year, and I missed it. It was a reminder of why many of us go into medicine. I didn’t go into medicine for glory or fame. Nor did I go into medicine for financial reward. Still, I often told the resident physicians I was training, after seeing a particularly kind patient, ‘Can you believe we just got paid for seeing such a nice person?’ I went into medicine because I enjoyed helping people. Sometimes, we need a little reminder of that. Or, in this case, a big box of reminders.”
Marc L. Frost is a dermatologist.
He shares his story and discusses his KevinMD article, “Thanksgiving came early this year. I just didn’t appreciate it.
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Marc Frost. He is a dermatologist, and he wrote the KevinMD article “Thanksgiving came early this year. I just didn’t appreciate it.” Marc, welcome to the show.
Marc L. Frost: Thank you, Kevin. It’s great to be on.
Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?
Marc L. Frost: Sure. I grew up in rural Iowa, a small town, went to a small college nearby, and then went to the University of Iowa for medical school. I jokingly tell patients I moved to Indiana for the weather, when really I moved for my residency instead. So I did my dermatology residency at Indiana University Medical School and came to love Indiana. It’s the Midwest, and the people are great. So I decided to stay here and set up practice. For the last 32 years I practiced as a solo practitioner, and I eventually closed my practice and retired in June of this year.
Kevin Pho: And we are talking towards the end of January, in the worst wave of the pandemic. Now, from a dermatology standpoint, tell me what kind of patients you’ve been seeing over the last few months.
Marc L. Frost: Well, since I closed my office practice in June, what I’ve been doing is seeing nursing home patients about four or five days a month, and it’s a real eye-opener. Obviously, with these patients there was a lot of social isolation before COVID. Well, now it’s a big deal. There are a lot of people who are thrilled to see me because, well, I’m the only real person they’ve seen from the outside in months. Some have not even seen family members. A lot of them, if they leave their facility, they’re quarantined for 14 days, so they don’t want to leave if they don’t have to.
So I didn’t plan on that being a big part of my practice when I’m retired, but there’s a big social aspect to it. I’ve got plenty of time to spend with patients, and they like it because it’s one of the very few in-person social interactions they get to have nowadays.
Kevin Pho: All right, so let’s transition now into your KevinMD article, “Thanksgiving came early this year. I just didn’t appreciate it.” Now, for those who didn’t read that story, can you just share it with my audience and share why you decided to write it?
Marc L. Frost: Sure. The inspiration came just before Thanksgiving. So to back up, back in January of 2020, I decided I was going to go ahead and retire and close my practice. Well, no one expected what was going to happen in March, and by the time April 1 rolled around here in Indiana, I shut my practice completely. I did some telemedicine. Half my staff, I had four employees, and two of them quit because they were worried about getting COVID. There was just so much we didn’t know about COVID back then, and so they actually quit because they were afraid of contracting it.
May rolls around, and I had just sent out letters announcing I was going to retire, so there’s this massive floodgate of people who want to come in and see me for one last time. I just worked like gangbusters through May and June. We’re talking till late at night. I finally got done and closed June 30th.
During that spell, a lot of patients asked my staff, well, they’d like to get me a retirement gift, and I’m at the point in life where, yeah, I don’t need any more things. So I told them I’d just like a note or a card. These would come in, but sometimes I’d be busy and didn’t really have time to read them. I’d kind of take a quick glance at them and toss them in a file drawer that I had.
Well, I also owned my office building, and when I closed my practice, we put it up for sale. I had to clean it out, and it sold relatively quickly. So I brought all these boxes home, and at Thanksgiving my living room is piled up with all these things left over from my office. I found this box that had all these thank-you cards in there, and a lot of them I really had not gone through. So I got one out and read it, and read another one, and read another one, and next thing you know, after a couple of hours I’d gone through about 400-plus of them. It was a real eye-opener. During COVID, you were just so busy seeing people that you kind of forgot why you see patients, and people were very, very appreciative.
There were a lot of common themes. Some people said how they were my longest-surviving patient. That was a joke I always used with them: Not many people have dying dermatologists. They like to joke about that. Some of them went back to when I started my practice 32 years ago. Many were multigenerational; there were a lot of patients where I’ve seen four generations of their family. I had one patient who joked that I was the Mr. Rogers of dermatology, which I got a kick out of, because all along, all the years I practiced, I thought that was the basic minimum people should get in terms of good-quality care, and little did I realize that people thought that was a pretty big deal. So it was a real eye-opener.
And it’s something where, in your blog, in a lot of articles I read, there are a lot of folks with a lot of frustration out there, a lot of angst. I think sometimes we kind of lose sight of the fact that we’re actually doing a lot of good, and people actually appreciate that, but we get blinded to it. We just don’t really realize what we’re doing.
Kevin Pho: So as you were going through these 400-plus cards and letters, did anything surprise you, or did anyone write anything that surprised you among those cards?
Marc L. Frost: Probably the biggest surprise was the number of patients who I didn’t think liked me and wrote me a card. I was not expecting that. I think sometimes we kind of judge our interactions with patients, and we think, “I don’t really mesh with that person. They don’t really like me, or they don’t respect me, or they don’t think I know what I’m doing,” when the reality is, I think they appreciate that even if they’re not getting better, they can still tell you’re trying hard to help them. Maybe they recognize that maybe they don’t mesh with you either, but they still think you’re trying to do the best you can for them.
So that was probably the biggest surprise, that there were no patients who I was stunned. In fact, I was actually kind of afraid to open those letters, thinking, “What were they going to write?” And they were generally pretty complimentary. So that was a big surprise.
Kevin Pho: So after practicing dermatology for 30-plus years, how has the field changed during your time?
Marc L. Frost: Technology is the big one. Even an old fogey like me has to learn, “OK, I’m going to learn how to adjust to electronic medical records.” There’s a lot of video now. There was a super learning curve during COVID, those couple of months I practiced doing telemedicine, and I think that’s going to be a big help to patients down the road. So many times I would see kids who would go off to college, and you might get some follow-up on how their problem was doing. Or, I practiced in the center of the state, and I had some patients who would drive sometimes from several hundred miles away, and there’s a big blizzard and they still want to make their fall visit.
And trying telemedicine, I think there’s a real use for it, in particular in dermatology. Now, there are some limitations, where exams are kind of hard, but if you’ve got kind of a working diagnosis and you’ve already established some ongoing therapy, I think it’s going to be a real boon for a lot of patients who don’t have physical access to seeing a doctor.
Kevin Pho: And what do you see as some of the challenges for dermatology going forward?
Marc L. Frost: Well, it’s the same thing. It’s technology; it changes quickly. It’s funny, I went ahead to Zoom and talk with a pre-med club at a local high school, and they said, “Well, what should I major in, biology, chemistry?” And I said, “You know, computer technology might not be a bad idea, or computer science.” I have a son who is a technology expert for a local energy company here, and he always makes fun of our EMRs, because he goes, “How can they be so hard to use, so non-intuitive?”
And I think if we had physicians who actually had formal training in computer technology or computer science, we could design EMRs that would be useful to us, that would be very intuitive, that wouldn’t be a burden to us, that wouldn’t be getting in the way between us and seeing patients. So I think that’s a big challenge, and I would welcome again seeing kids major in things like computer science, computer technology, maybe electrical engineering, things like that, where the technology aspect wouldn’t be a big hurdle for them like it would be for me.
Kevin Pho: So speaking of technology, I see a lot of apps and a lot of companies trying to computerize dermatologic diagnoses. You take a picture of a skin lesion, and they can use various algorithms to predict what the diagnosis would be. Now, do you see a future for that? And do you also see a place for human dermatologists to continue their role in diagnosis, or do you see technology kind of infringing on that?
Marc L. Frost: That’s a great question. Again, going back to when I started doing telemedicine during COVID, you realize where technology is going to be helpful and where the big limitations are. I think the biggest limitations are in making the diagnosis. For one, we’re more than just two-dimensional. Our specialty is 3D. We’re actually looking at and touching things, and it’s hard to examine the whole patient remotely. So for people who have limited, straightforward problems, I think it’s pretty helpful.
Where it wasn’t as helpful, and I think there’s been a lot of effort looked at, but we keep running into snags, is going to be diagnosing malignancies. Just too often, things that look benign end up being malignant, and vice versa. So I think there’s going to be a lot more effort looking into how we can try to improve that.
But I think where it’s going to really be helpful is from a screening perspective. For one, we can try to determine, “OK, maybe I can’t make that diagnosis right there by looking at that.” But I think we could at least screen who needs to be moved up the chain of priority to be seen sooner. And likewise, if there’s been treatment established, I think it’s going to be helpful from a follow-up standpoint, where we’re doing more fine-tuning, and it’s not going to be quite as reliant on being able to do a full exam.
Kevin Pho: We’re talking to Marc Frost. He’s a dermatologist, and he wrote the KevinMD article “Thanksgiving came early this year. I just didn’t appreciate it.” Marc, you were in private practice for 30-plus years, and that is actually a minority of physicians. As you know, fewer and fewer physicians are going into private practice, and they’re being bought out by private equity, or they’re being bought out by larger hospital systems. Now, what are some of the challenges that you faced as a solo private practitioner over the last few years?
Marc L. Frost: Well, probably the biggest challenge over that whole time would be that I had the worst boss ever. I’m referring to myself, of course. And that means that you can’t wait for someone else to take care of something. You are the complaint department, and everything has to come back to your shoulders.
The biggest challenge is going to be being able to just keep up with all the change you’ve got to do. You’re busy seeing patients during the day, so that means in the evenings, at night. Often you’re not big enough to have a full-time person who’s doing technology stuff, so you have to be able to not just embrace technology but to actually implement it. That’s, I think, the biggest challenge as a sole practitioner, just having the time to be able to factor that in.
Kevin Pho: So if you’re a newly graduated dermatologist and you’re making the decision about whether to go into private practice versus joining an established, large, integrated health care system, what are some of the factors that go into that decision-making process in terms of making the right choice for that particular dermatologist?
Marc L. Frost: Well, I think a big part would be your personality type. There are some people who are very entrepreneurial, and they like the idea of running their own show, being their own boss. But like I said, the problem with being your own boss is then you have the worst boss possible. If someone has that sort of mindset, that’s a big plus.
Yeah, I’m the luckiest guy in the world. Not only did I marry a great person, but my wife is a CPA who specialized in small business development. At the beginning, I knew nothing about setting up my own practice, trying to get the word out about the service I offer, things like that. To have someone there to help kind of guide me along with how you set up a business, how you apply for a loan, how you write a business plan, that was a big plus.
So my advice would be, hey, if you didn’t marry someone like that like I did, you’re going to need to find someone, hire someone like that. And if you talk to other sole practitioners, they should be able to give you the names of people who can get you going, kind of get you past those first big hurdles.
Kevin Pho: And my final question: What’s your take-home message you want to leave with the KevinMD audience?
Marc L. Frost: Well, my take-home message would be that, again, a lot of people write articles where you can tell that there’s, understandably, a lot of frustration, a lot of difficulties ahead of them, and we shouldn’t lose sight of what we’re trying to do in medicine. We’re trying to help people. That’s really why most of us went into medicine.
And I think if we just take the time with each patient visit to say, “OK, what did I learn today, what I learned from this patient?” A lot of times I’d walk over and go, “You know, can you believe how lucky I was to get to spend 10, 15, 20 minutes with that person? What a great person that was.” You actually get to meet a lot of great people over time. You get to establish a lot of great relationships. You get to help a lot of people over time. And not to lose sight of that. It’s really easy to kind of focus on what went wrong today, when the reality is you did a lot of good on that given day.
Kevin Pho: Well, Marc, best wishes on retirement. Thanks again for your time and insight, and thanks again for being on the show.
Marc L. Frost: Great, thank you. This is a great honor.
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