Invited response to the comment on “Dermatology residents and the care of COVID-19 patients”
Authors: Jane M. Grant-Kels
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: I am greatly appreciative to Dr Basil Patel for his comments1Patel B. Comment on "Dermatology residents and the care of COVID-19 patients.".J Am Acad Dermatol. 2020; 83: e49Abstract Full Text Full Text PDF Scopus (2) Google Scholar on the dermatoethics piece, "Dermatology residents and the care of COVID-19 patients."2Stoj V. Grant-Kels J.M. Dermatology residents and the care of COVID-19 patients.J Am Acad Dermatol. 2020; 82: 1572-1573Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar As someone who is intimately involved with dermatology residents at 2 universities, I am personally very aware of residents' concerns and fears regarding this pandemic. I will address each of the issues raised by Dr Patel. Although the fatality rate for those aged 20 to 49 years is lower, I recognize that any risk, when it is personal, is terrifying. I did not mean to imply that fear was not appropriate. Your assertion that theoretically upholding the Hippocratic Oath should make the fatality rate irrelevant has some merit. Although physicians, as you state, do not need to be martyrs, they need to fulfill their professional responsibility the same as a fireman running into a burning building. There is now personal protective equipment that reduces the infectivity rate substantially, if worn properly, which should be reassuring. I agree that having personal protective equipment available is crucial. Peggy Noonan penned an editorial in the Wall Street Journal published April 11-12, 2020. She reflected upon the " …selflessness of doctors and nurses, for instance, and how they do their jobs because it's a calling. This tells us what bravery looks like, but also what a vocation is, and how a vocation is a spiritual event."3Noonan P. A Holy Week Amid a National Tribulation. The Wall Street Journal; April 9, 2020.https://www.wsj.com/articles/a-holy-week-amid-a-national-tribulation-11586474599Date accessed: April 16, 2020Google Scholar I am very sensitive to the fact that many residents are young with spouses and children. The risk of returning home after caring for infectious patients is something I did not mention but was acutely aware of. The need to be concise and conform to the word limit of a letter prevented me from raising this issue. Finally, you raised the issue of power dynamics and that residents have little leverage. This implies that attendings are not fulfilling their obligation to care for these infectious patients. Emergency department and hospital attendings (many of whom, at many hospitals, include called-up dermatology attendings) are potentially jeopardizing their well-being just as you are. I hope that all are pitching in during this national emergency, not out of fear that their contract will not be renewed but "to fulfill the key human desire to be part of something—'to be part of Team Humanity,' to be useful."3Noonan P. A Holy Week Amid a National Tribulation. The Wall Street Journal; April 9, 2020.https://www.wsj.com/articles/a-holy-week-amid-a-national-tribulation-11586474599Date accessed: April 16, 2020Google Scholar I am pleased that you are proud to be helping your community, and I am confident your community is grateful to you. Those at the front line caring for these patients are heroes. This pandemic has tested all of us. I am hopeful that out of this trial we will grow as physicians and human beings. Thank you for your service. Comment on "Dermatology residents and the care of COVID-19 patients"Journal of the American Academy of DermatologyVol. 83Issue 1PreviewTo the Editor: As a dermatology resident who is currently redeployed to manage patients with COVID-19, I read this paper1 with great interest. There are several contextual factors that should be included in this discussion. Full-Text PDF