This week on the B-MED podcast our esteemed guest, Dr. Jeffrey Scales, dermatologist, entreprenuer and founder of the North Carolina Center for Dermatology, unpacks all things melanin, skin cancer and the importance of diversity in the field of dermatology. Dr. Scales shares the crucial role of protecting our skin from sun exposure, regardless of your skin tone and also enlightens us about the exciting journey of entrepreneurship in medical practice.
When it comes to the world of medicine, representation and access to healthcare are more important than ever. Through Dr. Scales' lens, we explore these critical issues. Our conversation also navigates the complex landscape of payment models in the medical sphere, underscoring how doctors balance their innate desire to help with the financial necessities of running a practice.
As we wrap up our engaging conversation, he shares his personal interests and hobbies during the bolus round, adding a personal touch to our enlightening chat. Don't miss this captivating conversation where we learn, grow, and understand the nuances of melanin, dermatology, entrepreneurship, and much more!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
So what is melanin?
That word, we hear it all thetime.
I'm melanated the melanin in myskin.
We're going to talk all aboutwhat melanin is today and much,
much more on this episode of theBlackMed Connect podcast with
our phenomenal guest, dr JeffreyScales.
He's a dermatologist and he'sthe founder of the North
Carolina Center for Dermatology.
(00:20):
On this episode we talk alittle bit about what melanin is
, skin cancer, about thepractice of dermatology and the
amazing things you can do as adermatologist to care for your
patients.
We also can't forget our bolusround where we asked Dr Scales
some rapid fire questions, butyou got to stick around to the
end to hear what his answers areto those amazing questions.
(00:43):
Let's jump right into theepisode.
Roll the music.
You mentioned a little bitabout the work-life balance that
you've been able to create withdermatology.
Can you share a little bitabout what were the
(01:04):
circumstances or what made youfound your own practice and how
did you go about doing that?
Because here on the BMICpodcast we're also really
excited about innovation andownership and entrepreneurship
and everything in between.
Can you share a little bitabout what it was like to start
your practice?
Speaker 2 (01:20):
Sure, at the time I started my practice it was a lot
more common than it is now.
Medicine has becomeincreasingly corporating.
Increasingly, you find thathospitals and hospital systems
monopolize a lot of the areaaround where they are.
It is much more challenging forpeople to consider something
like that now.
Dermatology still is one ofthose specialties that avails
(01:42):
itself of the opportunity to dothat, although diminishingly so.
It's nice to own my ownpractice.
There are some greatresponsibilities that come with
it, as well as some headachesthat come with it, but that's
going to be in any setting thatyou work.
My wife works at the hospitaland she is a division chief and
she's responsible for 12, 14doctors and she has certain
(02:03):
kinds of problems that sheexperiences.
I have different problems thatI experience things like making
payroll, checking what sort ofbenefits we offer, things like
that that really respond more tobeing a business owner.
There's working in a particularjob and there's working on a
particular job, so I'm oftenbalancing both those things.
(02:24):
Today I'm rushing around seeingpatients and then someone will
stop me and ask do we need to dothis transfer?
Is it time let's check onmedical benefit?
These things I get pulled inanother direction have to be a
different person, have to be abusiness person, and so I've
done so long now I've gottenused to it In many regards.
If you ask most doctors, allthey want is to practice
medicine.
That's what they're trained todo.
(02:45):
They want to take care ofpatients and make people better,
and that's very much my desireas well.
But I also have to balance thatother part.
Now you could work for a largehospital system much as you do
and my wife does.
But you also realize it's notjust invasions.
There's all sorts ofresponsibilities for your
division.
You have committees, you needto be on leadership roles that
(03:09):
you will play, particularly asyou're there longer, and so that
takes on a different type ofdemand.
So I think it's just decidingwhich you want.
But with that in mind, I'mfortunate I have my own small
private practice medicine.
Now I'm expanding into openinga small aesthetic center right
next door in some space on thatisland, and the open house will
(03:30):
be in early December I thinkDecember the 3rd be agreed upon
and that's fun and exciting.
That's choosing to do something.
That's very different.
It's very different type ofmedicine.
Well, consumer medicine ismedicine where people hey, can't
I just to have some servicesthat are not covered by
insurance, so the entireinsurance issue is different.
(03:51):
So it has given me theopportunity to develop some new
skills.
It's given me the opportunityto acquire certain assets and
things.
I give a perfect example of mycondo space, where I have my
practice and also where I havemy aesthetics, and it's
appreciated significantly sinceI've owned it.
So it's something that's reallyup game well with and learn to
be a landlord, as well as otherskills that come with that
(04:15):
learning how to get contractorsand get things repaired.
That's again another set ofskills that you don't
necessarily have to have if youwork in a big hospital system or
a big practice.
So, yes, it's had greatbenefits.
I really like the idea ofownership.
I've taught my children allthree of them that it's
important to own something.
It's not just to own a car orto own consumer items.
(04:36):
Those are things that we'rereally good at as a people.
We are great consumers.
We're some of the bestconsumers in the world.
We spend a disproportionateamount of money on certain
fields, certain types ofbusinesses that really depend on
us, but I think the ownershipof business, the benefits that
come with that including the taxbenefits that come with that
(04:57):
are important to consider.
Being an employee is good.
You can make a money as anemployee, but always you need to
have something on the side.
So my daughter is going toMadison and I've talked to her
about that.
I said, yeah, honey, and I'vetold all three of them but this
was one of the only ones thatlistens I told all three of them
you need to have some kind ofbusiness on the side.
You need to have something thatis working for you, that other
people are working for to helpbenefit you.
(05:20):
So a perfect example is this mywife and I purchased a small
condominium from her mother inMiami and we got it for a
reasonable price and we rentedout and it provides a certain
amount of money per month and,as I told my daughter, you have
people who go to work every day,who pay the rent, who put money
towards your education, towardsyour long-term benefit.
(05:40):
It will always be somethingthat you want.
It will appreciate.
That's the type of businessthat you need to have
indefinitely.
So there are tax benefits andthings, and you don't have to be
planned to be a big landlordforever, but you certainly can
do things like that that helpyou from a tax standpoint and
long-term asset benefit, and Ithink we all need to think about
(06:03):
that.
If it's not that business, itcan be something else.
I started a little line ofproducts here which called Dr
Clear Skin, and I like it verymuch and it's slowly growing.
It's never going to be L'Orealor Revlon or something like that
, but it's something I do andit's something that, again, I
get some benefit from in termsof learning to be an owner, and
(06:24):
so I am trying to teach all ofmy children and everyone I can
talk to about the importance ofowning assets, things that
appreciate.
We spend a lot of money onthings that depreciate cars,
vacations, food, all theseexperiences.
There's nothing wrong with anyof those things, but those have
to be things that you do alongwith the other things.
You should always be lookingfor something to be involved
(06:46):
with, be it some kind of smallbusiness it could be a lawn
mowing business or something orsomething Just something that
you can have, that you can starton your own and you can build
into.
It doesn't have to be somethingyou start off really big, as I
tell them, you have to besomething big.
But it has to be something big,because the ownership classes
in this country, as we've seen,are the ones that reap the
spoils of the economy that wehave, and be it Jeff Bezos or
(07:10):
Berkshire Hathaway or any ofthose things, those are
ownership issues and I know I'llnever be any of those people
when I'm seeing that aint.
But there's a reason thatpeople own things.
There's a reason that they owncompanies, swords, teams and
things like that.
We need to own those things aswell, because that's how you
develop economic clout in thesociety.
(07:31):
Now, how much you spend, butwhat assets you have.
What can you control?
What benefits your brain?
In that regard, for instance, Ihire.
I have a very diverse staff.
I have a number of people whoare Hispanic, a number of people
who are African American,someone from India, people, a
lady from Cuba.
These are people who, in manyregards, may not have had some
(07:51):
of the same opportunities to bein some of the positions that
they are, because sometimes theydon't necessarily get the
benefit of being hired in thesame way that other people are.
So I feel very good about that,about the opportunity to put
people in positions to do thingsthat perhaps they would not get
the same opportunity in otherplaces.
Speaker 1 (08:08):
I love that.
I love that.
I think to your point ofownership.
It's critical.
We are such a large consumergroup, we are constantly
consuming from others, so anyopportunities to talk about the
importance of ownership and evenyou know for I know a lot of
people in training now who evenhave small side hustles as
(08:30):
they're coming through training,and I think that's something
that's unique and interesting.
Or even for me, I wrote mychildren's book as a trainee.
So it doesn't have to, youdon't have to wait to start.
You may not be able to finisheverything at the same time, you
may have to kind of obviouslyput your emphasis on getting
through training or gettingthrough med school, but you can
(08:51):
start small, like you said, andit can hopefully grow.
So you know, thank you for thatadvice.
I'm listening, just as much as Ihope my audience is, to the
wisdom you're sharing, becauseownership is so critical,
especially in a time wherecorporate, like you're saying,
corporate medicine is takingover and changing the landscape
of medicine, and so I've alwaysadmired individuals who have
(09:15):
their own practices and peoplewho are starting maybe their own
direct primary care or directpractices as well.
So thank you for sharing thatimportance and value of
ownership, and you know that'swhat we're all about here
thinking about innovative andcreative ways to have our
careers, because it doesn't haveto look one particular way.
And so you mentioned youraesthetic clinic.
(09:37):
You mentioned your product line.
Can you share more about whatis your product line all about
and what will you be doing inyour new clinic when you want to
be separate?
Speaker 2 (09:45):
Sure.
So I started a little reallycurate a little product line
that I put together that focuseson assisting with shaving
difficulties.
So I have a number of steps ina little package that I put
together that should helpenhance people having successful
shaving.
There are quite a number ofpeople who have difficulty
(10:08):
shaving and I think that it'soften overlooked, particularly
among us, and I think there aresome things that we need to
consider, and so I have puttogether a few little products
which I think will make shavinga bit easier for both men and
women in the areas where theyshave.
So it's called Dr Clear Skin.
You mentioned the aestheticcenter, and the aesthetic center
is a place where some of thatsame interest will apply.
(10:29):
I have a particular laserthat's good for people of all
skin types to help withdecreasing the amount of hair
people grow in some areas.
There's a number of men andwomen that can benefit from
decreasing how much hair growsand complexity of some of the
shaving issues that come with it, and so that will take place
there, as well as a few othercosmetic items that we are going
(10:51):
to be offering chemical peels,microdermabrasion, laser
treatment, morpheus 8 treatmentsthings that have benefit for
many people and it's a very newavenue for us.
We've been doing some of itslowly, but it's something.
Now that we're taking a moreaggressive approach and a lot of
regards is funny.
(11:11):
I'm 62 years old and what a lotof people talk to me about is
when am I going to retire?
And frankly, I have no interestin retirement right now.
I read two good books thattalked about retirement and in
it they say never retire.
You don't have to continue towork as you are.
But if you're able to dosomething and you're capable
still, which I feel like I'mstill able to do both of what I
(11:32):
do then why stop?
For many people, what isretirement?
Retirement is sitting at home,watching TV, playing golf four
times a week, pinching yourpennies and hoping that your
Medicare is going to last.
Those are things that perhapsI'll get to at some point, but
at the moment I'm starting thisnew endeavor and I'm looking
forward to it.
I'm looking for the challenge.
My children are all grown.
(11:53):
I think my risk is less Somerisk, but it's less risk because
my wife and I are only two wereally have to take care of
right now.
So if it goes great which I'mconfident it will then I'm going
to be excited and there will bea new phase in my life when I
learn something.
If it is slow to start orperhaps doesn't go as I would
like it to, I can take some timeto redouble my efforts, learn
(12:15):
from it and keep moving.
So it's very interesting tohave a life.
I wouldn't have said that whenmy children were 17 and 18.
But now that they're well intotheir adult lives, I have a bit
more freedom to try something.
Speaker 1 (12:26):
Yeah, that's exciting .
I love that.
I love how you're taking us onthis journey of your career and
it ultimately doesn't stop right.
What you make it is how youmake it intriguing and
interesting, and what terms andtwists you're going to have to
not only keep it exciting foryou, but really benefit and
impact a lot of people as well.
You've spoken about the impacton patients.
(12:46):
You've spoken about how you'vebeen able to hire a diverse
staff, and now you're talkingabout ways in which you'll help
a different population ofpatients.
So I'm really appreciative andI'm learning a lot on this
podcast episode, as I hope myaudience is as well.
And you mentioned before or wemay not have talked about it
just yet, but you have yourpractice and we know that only
(13:09):
about 3% of all dermatologistsare black or African-American.
So what has it been like beingin this space as a person of
color, as a black individual,and what advice would you have
for someone who's trying topotentially go into a field
where diversity really isn'twhat we would like it to be?
(13:30):
What would be your thoughts onthat?
Speaker 2 (13:32):
So that's a good question.
Dermatologists are a wonderfulfield of medicine.
It's probably one of the mostchallenging to get into at this
particular point.
It wasn't always that way, butit is now, partly because it can
be quite easily practicedwithout worrying about a family.
You certainly can have a family, you can have it, you can work
(13:53):
part-time, you can workfull-time.
So in a lot of ways it's anideal bit of medicine, or a
field of medicine where you canachieve a lot of things.
It's very challenging to getinto, made very good efforts to
try to diversify, but it's oneof the least diverse fields of
medicine.
I think if you were to look atincome based upon the types of
specialties and you wouldcorrelate a line, a bunch of
(14:14):
graphs looking at the percentageof diversity both by sex and by
ethnicity, I think you wouldfind that the more expensive or
the greater the income is,especially the fewer people of
color, the fewer women that theyhave, be it neurosurgery,
orthopedics, dermatology,dermatology is making strides to
(14:37):
diversify itself, which is good.
One of the reasons is necessarybecause people of color need to
have people in variousspecialties that are prepared to
welcome them into theirpractices.
There are some practices thatprobably are not as inviting for
people of need with a color.
(14:57):
A perfect example is Medicaiduse.
So in our state adisproportionate number of
people on Medicaid are bothblack and white, but it's very
hard to find dermatologistswilling to even accept that.
So it affects people of color,it affects children and we're
one of the few private practiceswilling to accept that in our
area.
Certainly you have theuniversities like Duke and UNC
(15:20):
which do a great job of helping.
But I never wanted to limitaccess to what can be important
care to people on the basis ofwhether they are Medicaid or
Medicare.
Those people are people verymuch like my family.
Those are people, those are myrelatives, those are best.
From where I come.
(15:40):
I'm two generations fromsharecropping, literally two
generations from sharecropping.
So when I see these patients Isee my people, I see my family,
I see my cousins and mygrandmother.
So the idea of providingsomething for them that might be
necessary.
I don't in any way want tooverestimate my value as a
(16:03):
physician or the need thatpeople might have for me, but I
will say that there are a numberof us who just have great needs
and cannot access thingsbecause of limitations, be it
economic limitations andsometimes societal and social
limitations.
To watch what's happened inthis country after President
Obama became president and hisleaving and watching the
(16:25):
pendulum swing back in a lot ofways that I just thought were
inconceivable at this particulartime in American history has
really been eye-opening.
So, as I told my daughter whois going to spend it, says, a
part of what happens with peoplethat are doctors of color is
that you are the great equalizer.
You're the one that makes surethat when a person steps into a
room, regardless of theireconomics or regardless of their
(16:48):
ethnicity be they white, blackor otherwise that those things
aren't taken into considerationwhen medical decisions are made.
It will provide for them thecare that you would provide the
same for your family and yourfriends, regardless of their
backgrounds, and I consider thatpart of my role.
My role is to make sure thatpeople who sometimes don't get a
voice, don't get access tothings that are important to
them, have an opportunity tohave that in our setting.
(17:11):
And so you ask about diversityand dermatology.
What do you want to do to getdermatology?
So I did go off on a tangentthere a bit.
Speaker 1 (17:17):
No, that's a great tangent.
Before you go on, I want to saysomething to the audience about
what you mentioned.
You mentioned that Medicaidpatients are oftentimes not
accepted by certain practices inthe area and I think for our
audience, who may or may notunderstand that Medicaid doesn't
always pay the same amount forthe same procedures or the same
(17:39):
amount for the same thingsyou're doing in the clinic, as a
private insurance provider mayprovide or may pay.
So when a practice owner ismaking a decision or the clinic
is making a decision about howmany of a certain group of
patients they can take, a lot oftimes they're thinking about
the money aspect of it and nottaking into consideration that
(18:00):
black and brown individuals andthose of lower socioeconomic
status may be lumped in justbecause of that type of
insurance that they have or theMedicaid that they have.
You've mentioned it a few times, one with the practice example,
and even previously when youmentioned you're going to be in
a setting where you train with alot of Medicaid patients or
(18:21):
Medicare patients.
That's important to take intoconsideration too Because, again
, like you mentioned, dr Scales,if your individuals who are
doing the training aren't reallyconsiderate of the patients
they're taking care of?
What example are they going toset?
What type of culture will it beat the institution that you
train?
So it's all integrated.
(18:41):
And I don't think we talk aboutenough in our training and even
in our early careers about howthe payment models we are kind
of dealing with, whether theseare not by choice.
Right, we come into medicine tohelp people.
We don't think about what itcosts and, as you said, I think
about my grandmother or mymother or my auntie when I'm
just having a conversation witha patient.
(19:03):
But a lot of the decisions thatare made involve the money side
and the money exchange to keepthe lights on for some practices
and to make revenue as well.
So I just wanted to bring thatpart back into the conversation
because it intertwines a lotwith the patient care we provide
and the types of challengesthat we have as health care
(19:24):
professionals trying to give thebest care to our patients.
So I'll let you proceed, but Iwanted to reiterate that point
too.
Speaker 2 (19:31):
Yeah, I think it's all appropriate to think about
this.
I think in many regards, like Iwas telling my daughter again
when she's going to the clinic,I said you're there training to
be a doctor, but you, being adoctor represents in your
community something differentthan many other communities, one
so a perfect example.
She did really well at SpelmanCollege.
(19:52):
She was extremely good studentand she's very smart and she's
very motivated.
There were other collegestudents that would come to her
because she got admitted to theUniversity of Pennsylvania
through a particular programcalled the PATH program, where
they will identify you early asa person that's qualified to go
to their institution and theywill offer you early admission.
(20:13):
And she got that.
She didn't have to take DMCADor interviews or anything.
She had an interview for theprogram but anyway she got
admitted.
Very smart young lady.
But there were young otherstudents who were trying to do
the same thing.
They would come up to her andask her questions.
They would see her and hold herin a certain esteem and she
said to me you know, dad, gettired of people asking me about
these things.
I get tired of people saying,oh, you're that smart when they
did that and I say I understandyour point, honey, I understand
(20:36):
what you're trying to say, thatyou want to be seen like
everyone else.
You are like it.
But she was just because yougot this program, because you're
smart.
I mean, yeah, you're smart,that's fine.
You're very social, you get outand do things.
But realize that sometimes whatdo you represent?
You represent an opportunity inways that other people have not
seen before.
I've had patients come to myoffice and come great distances
(20:57):
and they'll bring their childrenand they'll say I want you to
see what a black doctor lookslike.
And it seems like a very smallissue.
It is a very small issue frommy point of view.
But what does that represent?
It represents seeingopportunity in a place where
they may never have seenopportunity before.
Hey, I had someone said hey,you look like my cousin.
(21:19):
So when they see me and I looklike their cousin, they realize
so my cousin could be a doctor,my family members can be a
doctor.
And you know I'm not going tosay that being a doctor is the
greatest thing.
It's not.
It's a nice profession, it'swonderful, I enjoy it.
But what you represent issomeone who's able to go out
into the greater society and toachieve things that are
(21:42):
challenging and to be like therest of us.
Opportunity, seeing yourself inpositions that you can't get.
Other people don't see you.
So a reminder, her, that speakto these people, talk to these
other kids because they see youas something that they would
aspire to be like.
So that's where those sorts ofthings come up.
So, yes, it is different.
(22:05):
My daughter's been with me whenwe're here in Durham and she's
seen people stop me and thank meand talk to me and it just
really made a really big impacton her and ever think of it.
It's like, hey, you're a greatdoctor, a doctor's skill is kind
of thing, because that'sdefinitely isn't the case in
that regard.
But what it then representsagain is communities that are
(22:26):
striving to do better things.
So it's much more than just thepractice of medicine in the
role that you play.
Speaker 1 (22:34):
Absolutely, absolutely.
I love that.
I love that the communityreally does admire.
And it starts early.
It starts when you're in medschool, starts even when you're
in college and individuals aretrying to get to that stage.
So you kind of carry this badgeof honor almost for your
community, and even when we'renot thinking about it because I
know I oftentimes I'm notthinking about the fact that I'm
(22:56):
carrying this but other peopleare watching and looking up to
you and it's something that theyadmire.
So you bring up a great pointthere.
Hello everyone, are you enjoyingthe episode so far this week?
Well, I'm excited to announcethat this week's episode is
sponsored by the BMed app.
That's right, you heard it theBlackMed Connect app.
(23:18):
This app will be for any blackor brown, pre medical students,
medical students, residents,fellows and attendings, even for
institutions.
We're in the process ofdeveloping our app and we wanted
to share it with you now.
So if you're interested inreceiving updates on when the
BMed app will be available tothe world, then head on over to
(23:40):
bmedconnectcom slash app app andjoin the wait list.
Let's jump right back into theepisode.
I want to switch gears a littlebit, because I would like to
ask you for a little bit of yourdermatologic expertise here.
I'm going to actually startwith a very basic question,
because in the common vernacularright now we use the term
(24:02):
melanin a lot Melanin, melanatedskin.
Loving our skin, which we doCan you share with the audience
what is melanin and why dodifferent individuals or
different ethnicities havedifferent types or different
amounts of melanin?
Speaker 2 (24:16):
Sure.
So melanin is the color aspectof your skin.
With rare exception, everyonehas melanin in their skin.
Exceptions are people who are abit of LIGO, like Michael
Jackson and many others.
But it is a particular compoundthat's made in the skin to
protect the skin and some of thethings below the skin from
(24:39):
getting damaged as a result ofthe sun.
So the sun is wonderful, weneed it for vitamin D, we need
it for all sorts of things, butas it enters the skin it damages
the skin and the skin has torepair itself.
There's all these littlechemicals that are in the body
that are there that correct thedamage that takes place when
(24:59):
you're out in the sun.
So this happens every timeyou're out.
But your body corrects.
It also shields some otherthings below the skin by putting
up.
I like to think of it like anumbrella.
Melanin is like an umbrella inthe skin.
It keeps things from goingdeeper than it needs to.
Now, the more melanin you have,the less penetration of the sun
rays deeper into your skin, theless you have, the greater
(25:20):
chance you have of penetratingand leading to types of skin
cancer.
People of color and that's abroad word that I've been using,
a broad term I've been using.
But people of color generallyhave a baseline SPF of about
three.
Spf represents sun protectionfactor.
So if I put my skin out in thesun, how long does it take it to
(25:41):
turn red?
Then I apply the SPF and then Imeasure how long that same skin
takes to turn red again.
When you say three, that meansthat it took three times the
length of time to turn red thanit did before.
And that's true up to about SPF, about 15.
And then there are some otherfactors that come into play, but
anyway.
So melanin is there to protectthe inner parts of the body.
(26:05):
People ask well, if I get somesun, I get more melanin, don't I
?
I mean we all get a bright,brown or winter in the sun.
That's a great thing.
That's one of the adaptiveresponses that the body has
developed.
But along the way some damageis taking place that is
generally reversible but can becumulative, meaning at the more
sun I get over my lifetime, thebetter chance I have of skin
(26:26):
cancer, premature wrinkling fromsun.
So melanin is a great importantthing.
It is not the same thing asshade.
So I mean melanin doesn't meanyou won't get burned or that you
won't get skin cancer or thatyou can't have some of the
changes that come.
It just gives you a betterchance of avoiding those things
longer.
Speaker 1 (26:45):
Awesome, excellent, excellent.
And so if you could share alittle bit about skin cancer,
because you've mentioned it afew times here in this portion,
why is it that, as blackindividuals and black and brown
individuals, are they more orless likely to get skin cancer?
You mentioned the melaninprotection that we get.
Is the severity any different?
(27:06):
Can you speak a little bitabout the differences in skin
cancer by race and ethnicity?
Speaker 2 (27:10):
Sure.
So ethnicity, yes, every personis capable of having skin
cancer.
Having darker skin decreasesyour risk.
The last study I looked at,which is really quite old, says
that we have about one-tenth therisk of skin cancer that the
average person has.
The location person has.
Now that's very broad numbersthat you can't hold it to.
(27:32):
But basically what it says isthat our risk is lower if you
have brown skin.
Skin cancer is the most commoncancer in the United States.
What it means is the sun goesthrough the skin and it damages
particular cells in the skin.
So we talked about melaninbefore.
Melanin is created by theseparticular cells called
(27:52):
melanocytes.
Melanocytes job is to producethese little color packets and
to distribute them to the skinaround them.
But when damaged melanocytesbecome melanoma, melanoma is a
highly deadly type of cancerthat can affect all people.
Melanoma generally happens insome distributed areas, but you
(28:15):
can get melanoma in places likethe lining of the brain, the
back of the eye, all sorts ofthings.
So partly sun related, but notcompletely sun related.
So that's one type of skincancer that's probably the most
deadly one that we talk aboutcommonly.
Secondly, there is basal cellcarcinoma.
There are these cells calledbasal cells which help divide
and create new skin.
And then there's swamous cells.
Those are the cells in betweenthe basal cells in the top
(28:38):
layers of skin, and those twocan become skin cancer.
So those are the three mostcommon types that we talk about
and, as I said there, it is themost common type of cancer.
In the United States it'sprobably at least in excess of a
million cases a year.
The majority of them aretreated easily and repaired and
you go by your business.
But some of them can bechallenging.
Melanoma is very serious.
(28:59):
Squamous cell carcinoma can bevery serious.
Basal cell to a lesser degree,but still possible to be deadly.
Speaker 1 (29:06):
So what can people do ?
What should our listeners andthose who may be watching?
What should they look out for?
What should they tell theirfamily members to look out for
when they think about thepotential for skin cancer?
Speaker 2 (29:18):
Sure.
So it's hard to have easy,simple statements that make it
possible to determine all kindsof cancer in the skin, but there
are the five ABCDE criteria.
So A represents asymmetry,something that used to be round
but now it's not round anymore.
B border irregularity it isjacket around the edge.
(29:38):
C color variability Two colors,three colors in a particular
mole instead of just one.
D is diameter six millimetersor greater are the higher risk
lesions.
And E is evolution rate ofchange Is it changing slowly or
is it changing fast?
Those are commonrecommendations for people to
look at, and if they seeanything that looks remotely
(30:01):
suspicious, you should follow upwith a dermatologist Preferably
a dermatologist, someone whocan help interpret what they see
, and to get the specimen in thehands of a dermatopathologist,
a person that does nothing butstudy skin under the microscope.
Speaker 1 (30:15):
Absolutely so.
When people go to get theirphysicals, should they ask for
their doctors to kind of take alook at their moles, or what do
you think about that?
Speaker 2 (30:23):
I think ideally, that would take place.
No, I've had physicals in thelast few years.
People don't even take yourclothes off anymore.
It used to be you took yourclothes off.
Obviously we went for physicals.
That's changed quite a bit, soI think it's hard to get it
without specifically asking forit and with that in mind,
particularly if you are in ahigher risk category, meaning
you have fairer skin, it'sworthwhile then following up
(30:45):
with a dermatologist who cancheck your moles.
Speaker 1 (30:48):
Excellent, and so any parting words from a
perspective of this aspect, thedermatology aspect, before we
move to our bolus round, do youhave any parting words that you
wanna share with the listenersor those who are maybe watching?
Speaker 2 (31:02):
Sure.
So not only recommendations I'dsay is that pay attention to
your skin.
You can have your partner lookat the back and the areas that
you can't see.
If there's anything that looksunusual, maybe concerning maybe
something changing quickly, it'sworthwhile going to a doctor,
be it your primary care doctoror a dermatologist, and letting
someone look at it and let themcheck it.
I mentioned that earlier thatbrowner skin people have less
(31:26):
skin cancer, but one of thestatistics that comes up, or one
of the things that comes up, isthat when found, it tends to be
more advanced.
So part of it is that perhapsthere's some biology about that,
where browner skin people tendto have more aggressive skin
hazards.
Perhaps there's somesocioeconomics about that, that
people have less access todoctors who can catch these
(31:47):
cancers earlier.
And third, sometimes people arenot as comfortable looking at
certain skin diseases in brownerskin people.
So I think it's important thatIf you have anything that
remotely looks suspicious, letsomeone check it.
I've found all types of skincancers and all sorts of people
over in my life.
Speaker 1 (32:02):
Great advice and great wisdom there and even
mentioning we don't always evenlearn about different skin
conditions on different shadesof skin or different complexions
.
So I think there's a big pushnow, even in medical education
and even in books and intextbooks, to include
individuals of all differentskin tones.
(32:23):
So even bringing that up isreally important.
So I do want to thank you forsharing with us, but we
definitely have to still do ourbolus round here.
So the bolus round for thosewho may not have heard of this
before is our fun rapid fireround that we do with our guests
, similar to when we give abolus in medicine, which is when
we give a large amount offluids rather quickly.
(32:44):
If a patient may be in atraumatic situation or maybe has
an infection or dehydrated, wegive that bag of fluid and we
call that a bolus.
So if you don't mind, dr Scales, we're going to jump into our
bolus round.
Are you ready?
Speaker 2 (32:58):
Let's do it.
Speaker 1 (33:04):
All right.
So my first question for you isare you a Duke fan or a Tarhill
fan?
Or I'll even give you theopportunity to say if you're an
other fan.
Speaker 2 (33:14):
Sure.
So when I first moved here,people asked me which did I like
best, duke or UNC?
Now I had come from Maryland,suburban Washington, so we had
the University of Maryland andall of them were in the ACC at
that time.
So I would say Maryland.
People like no seriously whichwas Duke or UNC.
So I appreciate good sports, Ilike Duke and UNC.
My wife happens to work at UNCso right now I cheer as a
(33:35):
Tarhill but I'm always happy tosee teams in the area do well.
I've lived places where collegesports were not very big, like
in Cincinnati, and even in theWashington DC area was to a
lesser degree.
I was there when Georgetown wasreally big in college
basketball but college footballwas not quite as big a sport
there as pro football.
Speaker 1 (33:54):
Awesome, awesome.
I often run into the problem ofnot knowing who I want to root
for either.
So, being a Duke med grad and aUNC Chapel Hill pediatrician,
it's a hard choice of what colorblue I'm going to go for on a
given day.
Speaker 2 (34:09):
Yes, I can understand that.
Speaker 1 (34:12):
All right.
So if you had to choose onevacation, would you choose a
warm weather destination or acold weather destination, and
where would you go?
Speaker 2 (34:19):
Warm- weather, without a doubt.
The bulk of my vacations arewarm weather.
I do like to ski in coldtemperatures.
I don't get to do it very often.
I probably ski once everycouple years, and that might be
five to seven days.
But I'll go through the acouple warm weather vacations
two, three, four times a year.
Yes, I love warm weather.
Speaker 1 (34:38):
Fantastic, fantastic.
Well, if you had to choose onesport to watch, which sport
would you watch for the rest ofyour life?
Speaker 2 (34:46):
That's a great question.
I'd probably watch basketball.
I like pro basketball andcollege basketball.
I like pro football and collegefootball as well, so I couldn't
go wrong with any of thosethings.
So if I had to just choose onepro and college I'd probably
watch the NBA.
Speaker 1 (35:00):
Fantastic.
What's your favorite team?
Speaker 2 (35:02):
So in the NBA, I am from the Washington DC area, and
so we have the WashingtonWizards, which used to be the
Washington Bullets.
Most of you are too young toever have known that, but it is.
I'd probably say it's myfavorite team.
They're not competitive.
They haven't been competitivein a long time.
So I enjoy good basketball, nomatter who plays it.
I'd love to see Washington dowell, but that's going to be
(35:25):
some time.
I think, yeah, that's going tobe some time.
Speaker 1 (35:28):
Absolutely Well.
Okay, a few more questions here.
If you had to choose what typeof music you want to listen to
whether that be gospel or R&B orrap or hip hop or reggae or
jazz what genre would you pickin?
Who's your favorite artist?
Speaker 2 (35:42):
Wow, I like many different types of.
I had to just choose one.
So I like reggae, I likeclassic jazz, I like smooth jazz
, I like.
I do like some classical.
I've been listening to Afrobeats lately.
I really have enjoyed that andso it's hard to narrow it down.
I'd like hip hop.
I'd listen to old school.
I really would rap just firstgame out.
So I've been listening to thatsince the beginning, back to the
(36:03):
Sugar Hill game.
So I like everything I did.
Some of it now has gotten a bitout of hand.
It's a bit too violent, big twocorporate.
So I've had to choose one.
It really depends on the day.
Some days I'm feeling a littlebit down.
I put on some really hardcorerap and I like.
And there's some days I justfeel like listening to jazz.
I listen to a fair amount ofjazz, so probably tend to go to
(36:23):
concerts.
Someone says, choose a concertto go to.
I would go to a jazz concert.
Speaker 1 (36:27):
Fantastic, fantastic, and I love that Jazz Afro beats
all of the above.
You need all of them.
I feel like for them, whatevermood you're in.
Speaker 2 (36:35):
Yes, and reggae I like a lot too.
I really like reggae.
Speaker 1 (36:38):
Wonderful and okay.
Last question would you share alittle bit more, just one more
time, for our listeners aboutyour organization and how they
can find you and if they wouldlike to come and see what you're
doing, even as a patient, cometo see you.
If you could share someinformation there.
Speaker 2 (36:54):
Sure, I'm at the North Carolina Center for
Dermatology in Durham, northCarolina.
Our number here is 919-484-9551.
You can find us on the web,nccdermatologycom.
We have a Facebook page,instagram as well, so you can
find us there.
You can find me also under DrClear Skin, dr Jeffree Scales.
(37:17):
I am available to be reachedhere.
We have a website as well,where we take new patients, of
course, and that website alsoincludes a place for you to send
email if you're interested, soI can be found many different
places.
Speaker 1 (37:31):
Excellent.
Well, thank you for sharingthat, and if you're in this area
, I can't leave without askingyou your favorite restaurant in
this area.
So if someone's coming to seeyou and also wants to get
something to eat, where wouldyou send them?
Speaker 2 (37:42):
Yeah, I'm a real foodie.
I love eating in restaurantsaround here, be it Raleigh,
durham, chapel Hill.
I'm biased towards the Durhamrestaurants.
I think they happen to be thebest.
If I had to choose a restaurant, and with that in said, I'll
choose probably my favoriterestaurant in the areas of
restaurant, called Lanterry,which is in Chapel Hill.
Believe it or not, it's a mixof southern and Asian food.
(38:04):
I also like a restaurant inRaleigh which I was eating it
last weekend called BreweryBrevana.
It's both a brewery and theAsian restaurant and a bookstore
, all wrapped up in one Reallyelegant looking place.
I like that place, and thenthere's a long list of others
that I like.
So in an effort not to boreanyone, but yes, I definitely
like there's one in Raleigh too,called Death in Taxes, which I
(38:26):
really like.
Speaker 1 (38:26):
What a name.
Speaker 2 (38:28):
I go to everything around here barbecue restaurants
, asian restaurants and I likegood Mexican food too.
Speaker 1 (38:35):
Fantastic.
Well, I just want to say thankyou so much for your time.
I know I've gained a lot ofwisdom from this episode.
I hope the listeners have aswell in those who are watching.
And so, if you don't mindliking this episode, if you're
on YouTube and subscribing tothe channel and if you are
listening, be sure to follow theBlack Med Connect podcast for
(38:56):
more fantastic episodes.
And I just want to say againthank you, dr Skills, and until
next time, always remember formy audience to dream without
limits.
All right, bye bye, byeeveryone.
We hope you enjoyed this episodewith Dr Jeffrey's skills.
We had an amazing conversationwhere we talked about certain
skin conditions and skin cancers, as well as the importance of
(39:20):
diversity within the field ofdermatology, and so much more.
We appreciate our guests fortaking time out to have this
amazing conversation.
We also had a lot of fun duringour bowlers round learning more
about Dr Skills and hisinterests.
If you're interested inlearning more about how to
connect with Dr Skills, visitnccdermatologycom to learn more
(39:44):
and be sure to check out the DrClear Skin product line as well.
If you enjoyed thisconversation, comment below and
tell us what you learned or whatyou took away from the episode.
Don't forget to smash that likebutton.
Go ahead, do it right now.
Go ahead, smash that likebutton.
If you're on YouTube and if youhaven't subscribed to the
channel yet, what are you doing?
(40:05):
Go ahead and hit that subscribebutton as well.
If you're listening on allpodcast platforms, go ahead and
hit that follow button.
Thank you again, dr Skills, andto all our listeners out there
or those who are watching.
Always remember to dreamwithout limits.
Bye.
So what is melanin?
That word, we hear it all thetime.
I'm melanated the melanin in myskin.
We're going to talk all aboutwhat melanin is today and much,
much more on this episode of theBlackMed Connect podcast with
our phenomenal guest, dr JeffreyScales.
He's a dermatologist and he'sthe founder of the North
Carolina Center for Dermatology.
(00:20):
On this episode we talk alittle bit about what melanin is
, skin cancer, about thepractice of dermatology and the
amazing things you can do as adermatologist to care for your
patients.
We also can't forget our bolusround where we asked Dr Scales
some rapid fire questions, butyou got to stick around to the
end to hear what his answers areto those amazing questions.
(00:43):
Let's jump right into theepisode.
Roll the music.
You mentioned a little bitabout the work-life balance that
you've been able to create withdermatology.
Can you share a little bitabout what were the
(01:04):
circumstances or what made youfound your own practice and how
did you go about doing that?
Because here on the BMICpodcast we're also really
excited about innovation andownership and entrepreneurship
and everything in between.
Can you share a little bitabout what it was like to start
your practice?
Speaker 2 (01:20):
Sure, at the time I started my practice it was a lot
more common than it is now.
Medicine has becomeincreasingly corporating.
Increasingly, you find thathospitals and hospital systems
monopolize a lot of the areaaround where they are.
It is much more challenging forpeople to consider something
like that now.
Dermatology still is one ofthose specialties that avails
(01:42):
itself of the opportunity to dothat, although diminishingly so.
It's nice to own my ownpractice.
There are some greatresponsibilities that come with
it, as well as some headachesthat come with it, but that's
going to be in any setting thatyou work.
My wife works at the hospitaland she is a division chief and
she's responsible for 12, 14doctors and she has certain
(02:03):
kinds of problems that sheexperiences.
I have different problems thatI experience things like making
payroll, checking what sort ofbenefits we offer, things like
that that really respond more tobeing a business owner.
There's working in a particularjob and there's working on a
particular job, so I'm oftenbalancing both those things.
(02:24):
Today I'm rushing around seeingpatients and then someone will
stop me and ask do we need to dothis transfer?
Is it time let's check onmedical benefit?
These things I get pulled inanother direction have to be a
different person, have to be abusiness person, and so I've
done so long now I've gottenused to it In many regards.
If you ask most doctors, allthey want is to practice
medicine.
That's what they're trained todo.
(02:45):
They want to take care ofpatients and make people better,
and that's very much my desireas well.
But I also have to balance thatother part.
Now you could work for a largehospital system much as you do
and my wife does.
But you also realize it's notjust invasions.
There's all sorts ofresponsibilities for your
division.
You have committees, you needto be on leadership roles that
(03:09):
you will play, particularly asyou're there longer, and so that
takes on a different type ofdemand.
So I think it's just decidingwhich you want.
But with that in mind, I'mfortunate I have my own small
private practice medicine.
Now I'm expanding into openinga small aesthetic center right
next door in some space on thatisland, and the open house will
(03:30):
be in early December I thinkDecember the 3rd be agreed upon
and that's fun and exciting.
That's choosing to do something.
That's very different.
It's very different type ofmedicine.
Well, consumer medicine ismedicine where people hey, can't
I just to have some servicesthat are not covered by
insurance, so the entireinsurance issue is different.
(03:51):
So it has given me theopportunity to develop some new
skills.
It's given me the opportunityto acquire certain assets and
things.
I give a perfect example of mycondo space, where I have my
practice and also where I havemy aesthetics, and it's
appreciated significantly sinceI've owned it.
So it's something that's reallyup game well with and learn to
be a landlord, as well as otherskills that come with that
(04:15):
learning how to get contractorsand get things repaired.
That's again another set ofskills that you don't
necessarily have to have if youwork in a big hospital system or
a big practice.
So, yes, it's had greatbenefits.
I really like the idea ofownership.
I've taught my children allthree of them that it's
important to own something.
It's not just to own a car orto own consumer items.
(04:36):
Those are things that we'rereally good at as a people.
We are great consumers.
We're some of the bestconsumers in the world.
We spend a disproportionateamount of money on certain
fields, certain types ofbusinesses that really depend on
us, but I think the ownershipof business, the benefits that
come with that including the taxbenefits that come with that
(04:57):
are important to consider.
Being an employee is good.
You can make a money as anemployee, but always you need to
have something on the side.
So my daughter is going toMadison and I've talked to her
about that.
I said, yeah, honey, and I'vetold all three of them but this
was one of the only ones thatlistens I told all three of them
you need to have some kind ofbusiness on the side.
You need to have something thatis working for you, that other
people are working for to helpbenefit you.
(05:20):
So a perfect example is this mywife and I purchased a small
condominium from her mother inMiami and we got it for a
reasonable price and we rentedout and it provides a certain
amount of money per month and,as I told my daughter, you have
people who go to work every day,who pay the rent, who put money
towards your education, towardsyour long-term benefit.
(05:40):
It will always be somethingthat you want.
It will appreciate.
That's the type of businessthat you need to have
indefinitely.
So there are tax benefits andthings, and you don't have to be
planned to be a big landlordforever, but you certainly can
do things like that that helpyou from a tax standpoint and
long-term asset benefit, and Ithink we all need to think about
(06:03):
that.
If it's not that business, itcan be something else.
I started a little line ofproducts here which called Dr
Clear Skin, and I like it verymuch and it's slowly growing.
It's never going to be L'Orealor Revlon or something like that
, but it's something I do andit's something that, again, I
get some benefit from in termsof learning to be an owner, and
(06:24):
so I am trying to teach all ofmy children and everyone I can
talk to about the importance ofowning assets, things that
appreciate.
We spend a lot of money onthings that depreciate cars,
vacations, food, all theseexperiences.
There's nothing wrong with anyof those things, but those have
to be things that you do alongwith the other things.
You should always be lookingfor something to be involved
(06:46):
with, be it some kind of smallbusiness it could be a lawn
mowing business or something orsomething Just something that
you can have, that you can starton your own and you can build
into.
It doesn't have to be somethingyou start off really big, as I
tell them, you have to besomething big.
But it has to be something big,because the ownership classes
in this country, as we've seen,are the ones that reap the
spoils of the economy that wehave, and be it Jeff Bezos or
(07:10):
Berkshire Hathaway or any ofthose things, those are
ownership issues and I know I'llnever be any of those people
when I'm seeing that aint.
But there's a reason thatpeople own things.
There's a reason that they owncompanies, swords, teams and
things like that.
We need to own those things aswell, because that's how you
develop economic clout in thesociety.
(07:31):
Now, how much you spend, butwhat assets you have.
What can you control?
What benefits your brain?
In that regard, for instance, Ihire.
I have a very diverse staff.
I have a number of people whoare Hispanic, a number of people
who are African American,someone from India, people, a
lady from Cuba.
These are people who, in manyregards, may not have had some
(07:51):
of the same opportunities to bein some of the positions that
they are, because sometimes theydon't necessarily get the
benefit of being hired in thesame way that other people are.
So I feel very good about that,about the opportunity to put
people in positions to do thingsthat perhaps they would not get
the same opportunity in otherplaces.
Speaker 1 (08:08):
I love that.
I love that.
I think to your point ofownership.
It's critical.
We are such a large consumergroup, we are constantly
consuming from others, so anyopportunities to talk about the
importance of ownership and evenyou know for I know a lot of
people in training now who evenhave small side hustles as
(08:30):
they're coming through training,and I think that's something
that's unique and interesting.
Or even for me, I wrote mychildren's book as a trainee.
So it doesn't have to, youdon't have to wait to start.
You may not be able to finisheverything at the same time, you
may have to kind of obviouslyput your emphasis on getting
through training or gettingthrough med school, but you can
(08:51):
start small, like you said, andit can hopefully grow.
So you know, thank you for thatadvice.
I'm listening, just as much as Ihope my audience is, to the
wisdom you're sharing, becauseownership is so critical,
especially in a time wherecorporate, like you're saying,
corporate medicine is takingover and changing the landscape
of medicine, and so I've alwaysadmired individuals who have
(09:15):
their own practices and peoplewho are starting maybe their own
direct primary care or directpractices as well.
So thank you for sharing thatimportance and value of
ownership, and you know that'swhat we're all about here
thinking about innovative andcreative ways to have our
careers, because it doesn't haveto look one particular way.
And so you mentioned youraesthetic clinic.
(09:37):
You mentioned your product line.
Can you share more about whatis your product line all about
and what will you be doing inyour new clinic when you want to
be separate?
Speaker 2 (09:45):
Sure.
So I started a little reallycurate a little product line
that I put together that focuseson assisting with shaving
difficulties.
So I have a number of steps ina little package that I put
together that should helpenhance people having successful
shaving.
There are quite a number ofpeople who have difficulty
(10:08):
shaving and I think that it'soften overlooked, particularly
among us, and I think there aresome things that we need to
consider, and so I have puttogether a few little products
which I think will make shavinga bit easier for both men and
women in the areas where theyshave.
So it's called Dr Clear Skin.
You mentioned the aestheticcenter, and the aesthetic center
is a place where some of thatsame interest will apply.
(10:29):
I have a particular laserthat's good for people of all
skin types to help withdecreasing the amount of hair
people grow in some areas.
There's a number of men andwomen that can benefit from
decreasing how much hair growsand complexity of some of the
shaving issues that come with it, and so that will take place
there, as well as a few othercosmetic items that we are going
(10:51):
to be offering chemical peels,microdermabrasion, laser
treatment, morpheus 8 treatmentsthings that have benefit for
many people and it's a very newavenue for us.
We've been doing some of itslowly, but it's something.
Now that we're taking a moreaggressive approach and a lot of
regards is funny.
(11:11):
I'm 62 years old and what a lotof people talk to me about is
when am I going to retire?
And frankly, I have no interestin retirement right now.
I read two good books thattalked about retirement and in
it they say never retire.
You don't have to continue towork as you are.
But if you're able to dosomething and you're capable
still, which I feel like I'mstill able to do both of what I
(11:32):
do then why stop?
For many people, what isretirement?
Retirement is sitting at home,watching TV, playing golf four
times a week, pinching yourpennies and hoping that your
Medicare is going to last.
Those are things that perhapsI'll get to at some point, but
at the moment I'm starting thisnew endeavor and I'm looking
forward to it.
I'm looking for the challenge.
My children are all grown.
(11:53):
I think my risk is less Somerisk, but it's less risk because
my wife and I are only two wereally have to take care of
right now.
So if it goes great which I'mconfident it will then I'm going
to be excited and there will bea new phase in my life when I
learn something.
If it is slow to start orperhaps doesn't go as I would
like it to, I can take some timeto redouble my efforts, learn
(12:15):
from it and keep moving.
So it's very interesting tohave a life.
I wouldn't have said that whenmy children were 17 and 18.
But now that they're well intotheir adult lives, I have a bit
more freedom to try something.
Speaker 1 (12:26):
Yeah, that's exciting .
I love that.
I love how you're taking us onthis journey of your career and
it ultimately doesn't stop right.
What you make it is how youmake it intriguing and
interesting, and what terms andtwists you're going to have to
not only keep it exciting foryou, but really benefit and
impact a lot of people as well.
You've spoken about the impacton patients.
(12:46):
You've spoken about how you'vebeen able to hire a diverse
staff, and now you're talkingabout ways in which you'll help
a different population ofpatients.
So I'm really appreciative andI'm learning a lot on this
podcast episode, as I hope myaudience is as well.
And you mentioned before or wemay not have talked about it
just yet, but you have yourpractice and we know that only
(13:09):
about 3% of all dermatologistsare black or African-American.
So what has it been like beingin this space as a person of
color, as a black individual,and what advice would you have
for someone who's trying topotentially go into a field
where diversity really isn'twhat we would like it to be?
(13:30):
What would be your thoughts onthat?
Speaker 2 (13:32):
So that's a good question.
Dermatologists are a wonderfulfield of medicine.
It's probably one of the mostchallenging to get into at this
particular point.
It wasn't always that way, butit is now, partly because it can
be quite easily practicedwithout worrying about a family.
You certainly can have a family, you can have it, you can work
(13:53):
part-time, you can workfull-time.
So in a lot of ways it's anideal bit of medicine, or a
field of medicine where you canachieve a lot of things.
It's very challenging to getinto, made very good efforts to
try to diversify, but it's oneof the least diverse fields of
medicine.
I think if you were to look atincome based upon the types of
specialties and you wouldcorrelate a line, a bunch of
(14:14):
graphs looking at the percentageof diversity both by sex and by
ethnicity, I think you wouldfind that the more expensive or
the greater the income is,especially the fewer people of
color, the fewer women that theyhave, be it neurosurgery,
orthopedics, dermatology,dermatology is making strides to
(14:37):
diversify itself, which is good.
One of the reasons is necessarybecause people of color need to
have people in variousspecialties that are prepared to
welcome them into theirpractices.
There are some practices thatprobably are not as inviting for
people of need with a color.
(14:57):
A perfect example is Medicaiduse.
So in our state adisproportionate number of
people on Medicaid are bothblack and white, but it's very
hard to find dermatologistswilling to even accept that.
So it affects people of color,it affects children and we're
one of the few private practiceswilling to accept that in our
area.
Certainly you have theuniversities like Duke and UNC
(15:20):
which do a great job of helping.
But I never wanted to limitaccess to what can be important
care to people on the basis ofwhether they are Medicaid or
Medicare.
Those people are people verymuch like my family.
Those are people, those are myrelatives, those are best.
From where I come.
(15:40):
I'm two generations fromsharecropping, literally two
generations from sharecropping.
So when I see these patients Isee my people, I see my family,
I see my cousins and mygrandmother.
So the idea of providingsomething for them that might be
necessary.
I don't in any way want tooverestimate my value as a
(16:03):
physician or the need thatpeople might have for me, but I
will say that there are a numberof us who just have great needs
and cannot access thingsbecause of limitations, be it
economic limitations andsometimes societal and social
limitations.
To watch what's happened inthis country after President
Obama became president and hisleaving and watching the
(16:25):
pendulum swing back in a lot ofways that I just thought were
inconceivable at this particulartime in American history has
really been eye-opening.
So, as I told my daughter whois going to spend it, says, a
part of what happens with peoplethat are doctors of color is
that you are the great equalizer.
You're the one that makes surethat when a person steps into a
room, regardless of theireconomics or regardless of their
(16:48):
ethnicity be they white, blackor otherwise that those things
aren't taken into considerationwhen medical decisions are made.
It will provide for them thecare that you would provide the
same for your family and yourfriends, regardless of their
backgrounds, and I consider thatpart of my role.
My role is to make sure thatpeople who sometimes don't get a
voice, don't get access tothings that are important to
them, have an opportunity tohave that in our setting.
(17:11):
And so you ask about diversityand dermatology.
What do you want to do to getdermatology?
So I did go off on a tangentthere a bit.
Speaker 1 (17:17):
No, that's a great tangent.
Before you go on, I want to saysomething to the audience about
what you mentioned.
You mentioned that Medicaidpatients are oftentimes not
accepted by certain practices inthe area and I think for our
audience, who may or may notunderstand that Medicaid doesn't
always pay the same amount forthe same procedures or the same
(17:39):
amount for the same thingsyou're doing in the clinic, as a
private insurance provider mayprovide or may pay.
So when a practice owner ismaking a decision or the clinic
is making a decision about howmany of a certain group of
patients they can take, a lot oftimes they're thinking about
the money aspect of it and nottaking into consideration that
(18:00):
black and brown individuals andthose of lower socioeconomic
status may be lumped in justbecause of that type of
insurance that they have or theMedicaid that they have.
You've mentioned it a few times, one with the practice example,
and even previously when youmentioned you're going to be in
a setting where you train with alot of Medicaid patients or
(18:21):
Medicare patients.
That's important to take intoconsideration too Because, again
, like you mentioned, dr Scales,if your individuals who are
doing the training aren't reallyconsiderate of the patients
they're taking care of?
What example are they going toset?
What type of culture will it beat the institution that you
train?
So it's all integrated.
(18:41):
And I don't think we talk aboutenough in our training and even
in our early careers about howthe payment models we are kind
of dealing with, whether theseare not by choice.
Right, we come into medicine tohelp people.
We don't think about what itcosts and, as you said, I think
about my grandmother or mymother or my auntie when I'm
just having a conversation witha patient.
(19:03):
But a lot of the decisions thatare made involve the money side
and the money exchange to keepthe lights on for some practices
and to make revenue as well.
So I just wanted to bring thatpart back into the conversation
because it intertwines a lotwith the patient care we provide
and the types of challengesthat we have as health care
(19:24):
professionals trying to give thebest care to our patients.
So I'll let you proceed, but Iwanted to reiterate that point
too.
Speaker 2 (19:31):
Yeah, I think it's all appropriate to think about
this.
I think in many regards, like Iwas telling my daughter again
when she's going to the clinic,I said you're there training to
be a doctor, but you, being adoctor represents in your
community something differentthan many other communities, one
so a perfect example.
She did really well at SpelmanCollege.
(19:52):
She was extremely good studentand she's very smart and she's
very motivated.
There were other collegestudents that would come to her
because she got admitted to theUniversity of Pennsylvania
through a particular programcalled the PATH program, where
they will identify you early asa person that's qualified to go
to their institution and theywill offer you early admission.
(20:13):
And she got that.
She didn't have to take DMCADor interviews or anything.
She had an interview for theprogram but anyway she got
admitted.
Very smart young lady.
But there were young otherstudents who were trying to do
the same thing.
They would come up to her andask her questions.
They would see her and hold herin a certain esteem and she
said to me you know, dad, gettired of people asking me about
these things.
I get tired of people saying,oh, you're that smart when they
did that and I say I understandyour point, honey, I understand
(20:36):
what you're trying to say, thatyou want to be seen like
everyone else.
You are like it.
But she was just because yougot this program, because you're
smart.
I mean, yeah, you're smart,that's fine.
You're very social, you get outand do things.
But realize that sometimes whatdo you represent?
You represent an opportunity inways that other people have not
seen before.
I've had patients come to myoffice and come great distances
(20:57):
and they'll bring their childrenand they'll say I want you to
see what a black doctor lookslike.
And it seems like a very smallissue.
It is a very small issue frommy point of view.
But what does that represent?
It represents seeingopportunity in a place where
they may never have seenopportunity before.
Hey, I had someone said hey,you look like my cousin.
(21:19):
So when they see me and I looklike their cousin, they realize
so my cousin could be a doctor,my family members can be a
doctor.
And you know I'm not going tosay that being a doctor is the
greatest thing.
It's not.
It's a nice profession, it'swonderful, I enjoy it.
But what you represent issomeone who's able to go out
into the greater society and toachieve things that are
(21:42):
challenging and to be like therest of us.
Opportunity, seeing yourself inpositions that you can't get.
Other people don't see you.
So a reminder, her, that speakto these people, talk to these
other kids because they see youas something that they would
aspire to be like.
So that's where those sorts ofthings come up.
So, yes, it is different.
(22:05):
My daughter's been with me whenwe're here in Durham and she's
seen people stop me and thank meand talk to me and it just
really made a really big impacton her and ever think of it.
It's like, hey, you're a greatdoctor, a doctor's skill is kind
of thing, because that'sdefinitely isn't the case in
that regard.
But what it then representsagain is communities that are
(22:26):
striving to do better things.
So it's much more than just thepractice of medicine in the
role that you play.
Speaker 1 (22:34):
Absolutely, absolutely.
I love that.
I love that the communityreally does admire.
And it starts early.
It starts when you're in medschool, starts even when you're
in college and individuals aretrying to get to that stage.
So you kind of carry this badgeof honor almost for your
community, and even when we'renot thinking about it because I
know I oftentimes I'm notthinking about the fact that I'm
(22:56):
carrying this but other peopleare watching and looking up to
you and it's something that theyadmire.
So you bring up a great pointthere.
Hello everyone, are you enjoyingthe episode so far this week?
Well, I'm excited to announcethat this week's episode is
sponsored by the BMed app.
That's right, you heard it theBlackMed Connect app.
(23:18):
This app will be for any blackor brown, pre medical students,
medical students, residents,fellows and attendings, even for
institutions.
We're in the process ofdeveloping our app and we wanted
to share it with you now.
So if you're interested inreceiving updates on when the
BMed app will be available tothe world, then head on over to
(23:40):
bmedconnectcom slash app app andjoin the wait list.
Let's jump right back into theepisode.
I want to switch gears a littlebit, because I would like to
ask you for a little bit of yourdermatologic expertise here.
I'm going to actually startwith a very basic question,
because in the common vernacularright now we use the term
(24:02):
melanin a lot Melanin, melanatedskin.
Loving our skin, which we doCan you share with the audience
what is melanin and why dodifferent individuals or
different ethnicities havedifferent types or different
amounts of melanin?
Speaker 2 (24:16):
Sure.
So melanin is the color aspectof your skin.
With rare exception, everyonehas melanin in their skin.
Exceptions are people who are abit of LIGO, like Michael
Jackson and many others.
But it is a particular compoundthat's made in the skin to
protect the skin and some of thethings below the skin from
(24:39):
getting damaged as a result ofthe sun.
So the sun is wonderful, weneed it for vitamin D, we need
it for all sorts of things, butas it enters the skin it damages
the skin and the skin has torepair itself.
There's all these littlechemicals that are in the body
that are there that correct thedamage that takes place when
(24:59):
you're out in the sun.
So this happens every timeyou're out.
But your body corrects.
It also shields some otherthings below the skin by putting
up.
I like to think of it like anumbrella.
Melanin is like an umbrella inthe skin.
It keeps things from goingdeeper than it needs to.
Now, the more melanin you have,the less penetration of the sun
rays deeper into your skin, theless you have, the greater
(25:20):
chance you have of penetratingand leading to types of skin
cancer.
People of color and that's abroad word that I've been using,
a broad term I've been using.
But people of color generallyhave a baseline SPF of about
three.
Spf represents sun protectionfactor.
So if I put my skin out in thesun, how long does it take it to
(25:41):
turn red?
Then I apply the SPF and then Imeasure how long that same skin
takes to turn red again.
When you say three, that meansthat it took three times the
length of time to turn red thanit did before.
And that's true up to about SPF, about 15.
And then there are some otherfactors that come into play, but
anyway.
So melanin is there to protectthe inner parts of the body.
(26:05):
People ask well, if I get somesun, I get more melanin, don't I
?
I mean we all get a bright,brown or winter in the sun.
That's a great thing.
That's one of the adaptiveresponses that the body has
developed.
But along the way some damageis taking place that is
generally reversible but can becumulative, meaning at the more
sun I get over my lifetime, thebetter chance I have of skin
(26:26):
cancer, premature wrinkling fromsun.
So melanin is a great importantthing.
It is not the same thing asshade.
So I mean melanin doesn't meanyou won't get burned or that you
won't get skin cancer or thatyou can't have some of the
changes that come.
It just gives you a betterchance of avoiding those things
longer.
Speaker 1 (26:45):
Awesome, excellent, excellent.
And so if you could share alittle bit about skin cancer,
because you've mentioned it afew times here in this portion,
why is it that, as blackindividuals and black and brown
individuals, are they more orless likely to get skin cancer?
You mentioned the melaninprotection that we get.
Is the severity any different?
(27:06):
Can you speak a little bitabout the differences in skin
cancer by race and ethnicity?
Speaker 2 (27:10):
Sure.
So ethnicity, yes, every personis capable of having skin
cancer.
Having darker skin decreasesyour risk.
The last study I looked at,which is really quite old, says
that we have about one-tenth therisk of skin cancer that the
average person has.
The location person has.
Now that's very broad numbersthat you can't hold it to.
(27:32):
But basically what it says isthat our risk is lower if you
have brown skin.
Skin cancer is the most commoncancer in the United States.
What it means is the sun goesthrough the skin and it damages
particular cells in the skin.
So we talked about melaninbefore.
Melanin is created by theseparticular cells called
(27:52):
melanocytes.
Melanocytes job is to producethese little color packets and
to distribute them to the skinaround them.
But when damaged melanocytesbecome melanoma, melanoma is a
highly deadly type of cancerthat can affect all people.
Melanoma generally happens insome distributed areas, but you
(28:15):
can get melanoma in places likethe lining of the brain, the
back of the eye, all sorts ofthings.
So partly sun related, but notcompletely sun related.
So that's one type of skincancer that's probably the most
deadly one that we talk aboutcommonly.
Secondly, there is basal cellcarcinoma.
There are these cells calledbasal cells which help divide
and create new skin.
And then there's swamous cells.
Those are the cells in betweenthe basal cells in the top
(28:38):
layers of skin, and those twocan become skin cancer.
So those are the three mostcommon types that we talk about
and, as I said there, it is themost common type of cancer.
In the United States it'sprobably at least in excess of a
million cases a year.
The majority of them aretreated easily and repaired and
you go by your business.
But some of them can bechallenging.
Melanoma is very serious.
(28:59):
Squamous cell carcinoma can bevery serious.
Basal cell to a lesser degree,but still possible to be deadly.
Speaker 1 (29:06):
So what can people do ?
What should our listeners andthose who may be watching?
What should they look out for?
What should they tell theirfamily members to look out for
when they think about thepotential for skin cancer?
Speaker 2 (29:18):
Sure.
So it's hard to have easy,simple statements that make it
possible to determine all kindsof cancer in the skin, but there
are the five ABCDE criteria.
So A represents asymmetry,something that used to be round
but now it's not round anymore.
B border irregularity it isjacket around the edge.
(29:38):
C color variability Two colors,three colors in a particular
mole instead of just one.
D is diameter six millimetersor greater are the higher risk
lesions.
And E is evolution rate ofchange Is it changing slowly or
is it changing fast?
Those are commonrecommendations for people to
look at, and if they seeanything that looks remotely
(30:01):
suspicious, you should follow upwith a dermatologist Preferably
a dermatologist, someone whocan help interpret what they see
, and to get the specimen in thehands of a dermatopathologist,
a person that does nothing butstudy skin under the microscope.
Speaker 1 (30:15):
Absolutely so.
When people go to get theirphysicals, should they ask for
their doctors to kind of take alook at their moles, or what do
you think about that?
Speaker 2 (30:23):
I think ideally, that would take place.
No, I've had physicals in thelast few years.
People don't even take yourclothes off anymore.
It used to be you took yourclothes off.
Obviously we went for physicals.
That's changed quite a bit, soI think it's hard to get it
without specifically asking forit and with that in mind,
particularly if you are in ahigher risk category, meaning
you have fairer skin, it'sworthwhile then following up
(30:45):
with a dermatologist who cancheck your moles.
Speaker 1 (30:48):
Excellent, and so any parting words from a
perspective of this aspect, thedermatology aspect, before we
move to our bolus round, do youhave any parting words that you
wanna share with the listenersor those who are maybe watching?
Speaker 2 (31:02):
Sure.
So not only recommendations I'dsay is that pay attention to
your skin.
You can have your partner lookat the back and the areas that
you can't see.
If there's anything that looksunusual, maybe concerning maybe
something changing quickly, it'sworthwhile going to a doctor,
be it your primary care doctoror a dermatologist, and letting
someone look at it and let themcheck it.
I mentioned that earlier thatbrowner skin people have less
(31:26):
skin cancer, but one of thestatistics that comes up, or one
of the things that comes up, isthat when found, it tends to be
more advanced.
So part of it is that perhapsthere's some biology about that,
where browner skin people tendto have more aggressive skin
hazards.
Perhaps there's somesocioeconomics about that, that
people have less access todoctors who can catch these
(31:47):
cancers earlier.
And third, sometimes people arenot as comfortable looking at
certain skin diseases in brownerskin people.
So I think it's important thatIf you have anything that
remotely looks suspicious, letsomeone check it.
I've found all types of skincancers and all sorts of people
over in my life.
Speaker 1 (32:02):
Great advice and great wisdom there and even
mentioning we don't always evenlearn about different skin
conditions on different shadesof skin or different complexions
.
So I think there's a big pushnow, even in medical education
and even in books and intextbooks, to include
individuals of all differentskin tones.
(32:23):
So even bringing that up isreally important.
So I do want to thank you forsharing with us, but we
definitely have to still do ourbolus round here.
So the bolus round for thosewho may not have heard of this
before is our fun rapid fireround that we do with our guests
, similar to when we give abolus in medicine, which is when
we give a large amount offluids rather quickly.
(32:44):
If a patient may be in atraumatic situation or maybe has
an infection or dehydrated, wegive that bag of fluid and we
call that a bolus.
So if you don't mind, dr Scales, we're going to jump into our
bolus round.
Are you ready?
Speaker 2 (32:58):
Let's do it.
Speaker 1 (33:04):
All right.
So my first question for you isare you a Duke fan or a Tarhill
fan?
Or I'll even give you theopportunity to say if you're an
other fan.
Speaker 2 (33:14):
Sure.
So when I first moved here,people asked me which did I like
best, duke or UNC?
Now I had come from Maryland,suburban Washington, so we had
the University of Maryland andall of them were in the ACC at
that time.
So I would say Maryland.
People like no seriously whichwas Duke or UNC.
So I appreciate good sports, Ilike Duke and UNC.
My wife happens to work at UNCso right now I cheer as a
(33:35):
Tarhill but I'm always happy tosee teams in the area do well.
I've lived places where collegesports were not very big, like
in Cincinnati, and even in theWashington DC area was to a
lesser degree.
I was there when Georgetown wasreally big in college
basketball but college footballwas not quite as big a sport
there as pro football.
Speaker 1 (33:54):
Awesome, awesome.
I often run into the problem ofnot knowing who I want to root
for either.
So, being a Duke med grad and aUNC Chapel Hill pediatrician,
it's a hard choice of what colorblue I'm going to go for on a
given day.
Speaker 2 (34:09):
Yes, I can understand that.
Speaker 1 (34:12):
All right.
So if you had to choose onevacation, would you choose a
warm weather destination or acold weather destination, and
where would you go?
Speaker 2 (34:19):
Warm- weather, without a doubt.
The bulk of my vacations arewarm weather.
I do like to ski in coldtemperatures.
I don't get to do it very often.
I probably ski once everycouple years, and that might be
five to seven days.
But I'll go through the acouple warm weather vacations
two, three, four times a year.
Yes, I love warm weather.
Speaker 1 (34:38):
Fantastic, fantastic.
Well, if you had to choose onesport to watch, which sport
would you watch for the rest ofyour life?
Speaker 2 (34:46):
That's a great question.
I'd probably watch basketball.
I like pro basketball andcollege basketball.
I like pro football and collegefootball as well, so I couldn't
go wrong with any of thosethings.
So if I had to just choose onepro and college I'd probably
watch the NBA.
Speaker 1 (35:00):
Fantastic.
What's your favorite team?
Speaker 2 (35:02):
So in the NBA, I am from the Washington DC area, and
so we have the WashingtonWizards, which used to be the
Washington Bullets.
Most of you are too young toever have known that, but it is.
I'd probably say it's myfavorite team.
They're not competitive.
They haven't been competitivein a long time.
So I enjoy good basketball, nomatter who plays it.
I'd love to see Washington dowell, but that's going to be
(35:25):
some time.
I think, yeah, that's going tobe some time.
Speaker 1 (35:28):
Absolutely Well.
Okay, a few more questions here.
If you had to choose what typeof music you want to listen to
whether that be gospel or R&B orrap or hip hop or reggae or
jazz what genre would you pickin?
Who's your favorite artist?
Speaker 2 (35:42):
Wow, I like many different types of.
I had to just choose one.
So I like reggae, I likeclassic jazz, I like smooth jazz
, I like.
I do like some classical.
I've been listening to Afrobeats lately.
I really have enjoyed that andso it's hard to narrow it down.
I'd like hip hop.
I'd listen to old school.
I really would rap just firstgame out.
So I've been listening to thatsince the beginning, back to the
(36:03):
Sugar Hill game.
So I like everything I did.
Some of it now has gotten a bitout of hand.
It's a bit too violent, big twocorporate.
So I've had to choose one.
It really depends on the day.
Some days I'm feeling a littlebit down.
I put on some really hardcorerap and I like.
And there's some days I justfeel like listening to jazz.
I listen to a fair amount ofjazz, so probably tend to go to
(36:23):
concerts.
Someone says, choose a concertto go to.
I would go to a jazz concert.
Speaker 1 (36:27):
Fantastic, fantastic, and I love that Jazz Afro beats
all of the above.
You need all of them.
I feel like for them, whatevermood you're in.
Speaker 2 (36:35):
Yes, and reggae I like a lot too.
I really like reggae.
Speaker 1 (36:38):
Wonderful and okay.
Last question would you share alittle bit more, just one more
time, for our listeners aboutyour organization and how they
can find you and if they wouldlike to come and see what you're
doing, even as a patient, cometo see you.
If you could share someinformation there.
Speaker 2 (36:54):
Sure, I'm at the North Carolina Center for
Dermatology in Durham, northCarolina.
Our number here is 919-484-9551.
You can find us on the web,nccdermatologycom.
We have a Facebook page,instagram as well, so you can
find us there.
You can find me also under DrClear Skin, dr Jeffree Scales.
(37:17):
I am available to be reachedhere.
We have a website as well,where we take new patients, of
course, and that website alsoincludes a place for you to send
email if you're interested, soI can be found many different
places.
Speaker 1 (37:31):
Excellent.
Well, thank you for sharingthat, and if you're in this area
, I can't leave without askingyou your favorite restaurant in
this area.
So if someone's coming to seeyou and also wants to get
something to eat, where wouldyou send them?
Speaker 2 (37:42):
Yeah, I'm a real foodie.
I love eating in restaurantsaround here, be it Raleigh,
durham, chapel Hill.
I'm biased towards the Durhamrestaurants.
I think they happen to be thebest.
If I had to choose a restaurant, and with that in said, I'll
choose probably my favoriterestaurant in the areas of
restaurant, called Lanterry,which is in Chapel Hill.
Believe it or not, it's a mixof southern and Asian food.
(38:04):
I also like a restaurant inRaleigh which I was eating it
last weekend called BreweryBrevana.
It's both a brewery and theAsian restaurant and a bookstore
, all wrapped up in one Reallyelegant looking place.
I like that place, and thenthere's a long list of others
that I like.
So in an effort not to boreanyone, but yes, I definitely
like there's one in Raleigh too,called Death in Taxes, which I
(38:26):
really like.
Speaker 1 (38:26):
What a name.
Speaker 2 (38:28):
I go to everything around here barbecue restaurants
, asian restaurants and I likegood Mexican food too.
Speaker 1 (38:35):
Fantastic.
Well, I just want to say thankyou so much for your time.
I know I've gained a lot ofwisdom from this episode.
I hope the listeners have aswell in those who are watching.
And so, if you don't mindliking this episode, if you're
on YouTube and subscribing tothe channel and if you are
listening, be sure to follow theBlack Med Connect podcast for
(38:56):
more fantastic episodes.
And I just want to say againthank you, dr Skills, and until
next time, always remember formy audience to dream without
limits.
All right, bye bye, byeeveryone.
We hope you enjoyed this episodewith Dr Jeffrey's skills.
We had an amazing conversationwhere we talked about certain
skin conditions and skin cancers, as well as the importance of
(39:20):
diversity within the field ofdermatology, and so much more.
We appreciate our guests fortaking time out to have this
amazing conversation.
We also had a lot of fun duringour bowlers round learning more
about Dr Skills and hisinterests.
If you're interested inlearning more about how to
connect with Dr Skills, visitnccdermatologycom to learn more
(39:44):
and be sure to check out the DrClear Skin product line as well.
If you enjoyed thisconversation, comment below and
tell us what you learned or whatyou took away from the episode.
Don't forget to smash that likebutton.
Go ahead, do it right now.
Go ahead, smash that likebutton.
If you're on YouTube and if youhaven't subscribed to the
channel yet, what are you doing?
(40:05):
Go ahead and hit that subscribebutton as well.
If you're listening on allpodcast platforms, go ahead and
hit that follow button.
Thank you again, dr Skills, andto all our listeners out there
or those who are watching.
Always remember to dreamwithout limits.
Bye.
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