I am a diagnostician at heart. Through my years of study and practice in dermatology, I have worked to develop a system that elucidates a fundamental approach to dermatologic diagnosis.
I trained in South Africa where the multitude of diseases we came across guaranteed a vigorous clinical training. Each week, our chief, Dr. Joy Schultz, would quiz us on clinical cases, determined to teach us how to appreciate even the most subtle clues that the skin can proffer. On a dermatology elective in Cape Town, I encountered a methodological approach to diagnosis for the first time. Dr. Paul Strauss, in between seeing his atopic dermatitis patients in a pediatric clinic one day, began to show me how the morphology of primary lesions, their grouping and distribution, as well as the history of the patient could guide one step by step to a differential diagnosis. I thank him for introducing me to this interactive way of thinking that was the genesis for what I have called the wheel of diagnosis.
I repeated a dermatology residency after moving to the United States. There, I was fortunate to be mentored by Dr. Michael Fisher, a master of differential diagnosis. Dr. Fisher introduced me to the concept of the reaction patterns that I have expanded upon in this book. At the Albert Einstein College of Medicine in the Bronx, we practiced differential diagnosis at Grand Rounds each week. We were not permitted to ask a history from the patients, except for three questions: "Does it itch?" "Does it burn?" and "Does it hurt?" Our eyes would have to do the rest diagnostically, and the residents built impressive lists of differential diagnoses in the discussions that followed.
In my subsequent years as an attending physician at New York University Medical Center, Beth Israel Deaconess Medical Center, and now at Brigham and Women's Hospital, honing my own diagnostic skills and teaching these skills to residents and students has remained my passion. I have learned so much from the incisive questions the residents have asked in our myriad interactive sessions; first at NYU and now here at Harvard. I have also worked to expand the original ideas of the wheel of diagnosis and the reaction patterns to encompass other useful algorithms and pathways to teach a comprehensive approach to differential diagnosis. A Guidebook to Dermatologic Diagnosis is an embodiment of this work.