REFLECTIONS OF A HAIR LOSS PHYSICAN

Dr. DONOVAN'S RECENT ARTICLES  

Hair loss is closely tied in to a patient's self identity and how they feel about themselves. A key part of being a hair loss physician is understanding that there is so much more to losing hair than losing hair.  There are a tremendous number of extremely complex emotions and psychological factors at play in anyone experiencing hair loss.  The following blogs describe some of these issues as well as reflections on some of the non-medical aspects of being a hair loss physician.

ARTICLE 1: Everybody has a story

We as physicians don't always come to know all the details of every patient's story  - but every patient has a story.

ARTICLE 2: The New Normal

Any patient with chronic disease fully understand the definition of the new normal. There is no good definition but it refers to a resetting of some kind of internal mechanism to deal with new changes in how one looks or feels after experiencing a change in his or her health.  

ARTICLE 3: The Uniqueness of Everyone's Hair Loss Story

Each and every patient with hair loss has a unique "story" to share about his of her hair loss. No two people are the same.  

ARTICLE 4: Tout is possible

Despite the odds and despite the statistics, I often remind patients that anything is possible

ARTICLE 5: Recognizing Grief

Few studies have been done on grief in patients with hair loss. Many patients with hair loss grieve according to classic patterns of grieving described by Dr Elisabeth Kugler-Ross some 50 years ago.

ARTICLE 6: Treating Hair Loss is about Logic not Guessing

Just like in a game of chess,  there is logic to planning each phase of treatment.  There is order. There is structure. 

ARTICLE 7: Primum non nocere and the modern S.A.F.E Principle

Primum non nocere closely mirrors a principle that I've shared with medical interns, residents and medical students for many years, namely treating patients in a manner that is "S.A.F.E". Treatments must be safe, affordable, feasible and effective.  

ARTICLE 8: The 8 Most Common Mistakes People Make about their Hair Loss

The 8 most common mistakes people make when it comes to the way patients deal with their hair loss.

ARTICLE 9: Principles of Philosophy: A Closer Look at Occam's Razor and Hickam's Dictum

 "Occam's razor" is a helpful guiding principle. It states that if there are two explanations for an occurrence, we should generally consider the simpler explanation as being the correct one. 'Hickam's dictum" is also a helpful guiding principle. The principle reminds us that a person can have more than one diagnosis and one need not try to explain everything with a single diagnosis.

ARTICLE 10: Dr. Seuss and Coping Strategies in Children

Children, like adults, develop strategies to cope with their hair loss.  These coping strategies change as the child ages.  Theodor Seuss Geisel (March 2, 1904 – September 24, 1991), was better known as Dr. Seuss. The words in his 46 children’s books impacted millions of children, including at least one child who used these words as a coping strategy for hair loss. Every now and then I find myself quoting Dr. Seuss when talking to children and their parents about hair loss. 

ARTICLE 11: Spiders, Rain and Hair Loss

We need to always make sure that detailed and rigorous scientific research methods are used to help clearly define which treatments help individuals with hair loss and which do not.  It’s common knowledge to many people that killing a spider will cause it to rain.  But is it really true? Does killing a spider cause it to rain?  To the best of my knowledge there has never been a scientific study examining the relationship between spider killing and rainstorm patterns. As a hair specialist, I hear myths about hair loss every day and consider it an important part of my practice to spend time with patients to help separate fact from fiction.  

ARTICLE 12: Preparing the Mind of the Young Physician to Recognize Hair Loss Patterns

The French philosopher and Nobel Prize winner Henri Bergson once said that the human mind sees only what it’s prepared to understand. I consider it a great privilege to teach about hair loss and help others open their minds to the many different types of hair loss that they will likely encounter in their patients in the years to come.  

ARTICLE 13: The 5D's of Stress: Some Stressful Life Events Actually Can Cause Hair Loss

Stresses that are high enough in magnitude can sometimes trigger increased hair shedding, especially stresses that fall into categories of what I call the “5 D’s” : 1. death of a loved one  2. divorce and relationship problems 3. debt and financial problems 4. new diagnosis for the patient or a loved one and 5. dismissal from a job. 

ARTICLE 14: On Self-Diagnosis

Nowadays, do-it-yourself (DIY) projects are very popular. A "DIY" Project is an activity that one undertakes without directly seeking the help of an expert.   The concept of DIY extends broadly into so many aspects of our lives nowadays.  The internet is full of DIY projects. On account of the internet, DIY also extends into medicine. The public is increasingly looking to take control of their health and in the same light to have more autonomy to decide how they receive advice on their health. The article reviews my view on self diagnosis of hair loss.

ARTICLE 15: On Practicing TWAD

A large percentage of the population practices what I term TWAD - or Treatment Without a Diagnosis. Here, I review two analogies I often use to help my patients understand why treating any condition without a proper diagnosis is not the ideal plan. 
 

ARTICLE 16: On the Reporting of 'Cures' in the Media

 The media frequently lives on a level of excitement and adrenaline that few humans can sustain for very long. In a world filled with much negative news, it is interesting that this does not seem to be the case when it comes to reporting about new hair research.  Every hair loss discovery adds to our body of knowledge but not every discovery needs to be reported as infinitely amazing.  

ARTICLE 17: Is alopecia areata a medical disease?

In my opinion, it's important to call alopecia areata a medical disease. It is important to have it recognized as medical disease in order to ensure that healthcare dollars and research resources are appropriated allocated to support this condition. Clearly, modern society has agreed that if one can't determine if something is a disease or not, it might not be worth allocating money to the area. 

ARTICLE 18: On the Use of Scalp Magnification by the Untrained

One needs to be weary of any clinic offering extensive advice based on the findings of magnified scalp examination, especially when using terminology that involves discussion about 'plugged follicles' and 'dying' hairs. Such terms are too often meant to scare and confuse.  When discussion is focused on hair density changes, inflammation, miniaturization, hair follicle calibre measurements (in micrometers), the likelihood that a valid assessment is being performed goes up considerably. Of course, it's still no guarantee and all patients must be aware of the basics of the "buyer beware" concepts.

ARTICLE 19: When an evidence based approach is just not enough

In the early days of medicine, physicians made recommendations to their patients based on their own previous experiences treating other patients. Over time, by witnessing which patients had their diseases improve and which did not, physicians would change their standard recommendations.  Nowadays, the new way of doctoring relies less on one’s previous experiences as a whole and more on the collective experiences of all health care providers around the world. If treatment X has proven itself in several countries or several good studies to be highly effective in treating disease Y, it quickly rises to the top of the list of the top treatment to be considered for any patient with disease Y.  We call this new era the era of ‘evidence based medicine.’ Although the first step in deciding on treatment is figuring out what has proven effective in other studies, the second step in deciding on treatment is deciding on what makes the most sense to the patient.  The most effective treatment is not always the treatment the patient begins. This is the concept behind what I have termed evidence based patient centered medicine (EBPCM).

ARTICLE 20: Dr. Donovan Interview with the Alopecia Project

An interview with Dr. Donovan on alopecia areata and being a physician who helps patients with the condition.  

ARTICLE 21: On Seeing The Bigger Picture

A reflection on Emily Carr and the ‘Bigger Picture’

ARTICLE 22: Listening to the Patient - and the Wise Words of Sir William Osler

William Osler was a Canadian physician and one of the 4 founding professors of John Hopkins Hospital . He was not only a physician but an educator, philosopher (and apparently a wonderful practical joker too). He is often honoured with the title as the “Father of Modern Medicine.” Hs teachings and words have influenced the practice and careers of countless physicians around the world.

ARTICLE 23: On the Chasing of Dreams

The dreams and ambitions of humans do not live inside of hair follicles. Rather, dreams live and are nurtured inside the human mind before they are finally translated by the individual into reality.

ARTICLE 24: Does the Hair Specialist Need Good Hair?

I usually answer this by asking if kidney doctors need good kidneys.

ARTICLE 25: The “Whatif”

In my clinic, a “whatif” is used as a condensation of the words “what & if”. Individuals with hair loss often spend a great deal of time & energy thinking about various “whatifs” and what they will say or do in certain situations.

ARTICLE 26: On the Meaning and Significance of Hair

The way two people think about their hair or their hair loss is not only unlikely to be the same - it’s also practically impossible. Our cumulative experiences from birth to the present influence how we come to view many things in our lives, including our hair.

ARTICLE 27: The Patient in the Room is Also An Expert

The patient is an expert in his or her hair loss. Nobody really knows more about all the facts surrounding their hair loss than they do. Of course, the patient might not even know they are an expert, but they are an expert. The patient knows when their hair loss started, which parts of the scalp are more affected by the hair loss than others, which parts itch and what seems to help the hair to grow. The patient can explain more about the ins and outs of their hair loss than anyone.

ARTICLE 28: Knowing When To Prescribe and When Not To Prescribe

Knowing when not to prescribe a medication is just as important as knowing when to prescribe it.

ARTICLE 29: What I’ve Learned From Answering 4000 Questions

ARTICLE 30: What is hope? How do you help others feel hopeful?

The four pillars of hope can be remembered by the four letters of the word hope - H.O.P.E. These remind us that hope is Honest, Optimistic, Patient and Evidence based.

ARTICLE 31: The Diagnostic Moment

The “diagnostic moment” refers to the point during the appointment that the patient first learns of their diagnosis. The diagnostic moment for many is the first step to coping. Regardless of what the diagnosis is or what prognosis this diagnosis pretends, having a diagnosis allows many patents to feel part of the world again.