Untitled Note | Dermatol Pract Concept 2015;5(2):7 55 DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com In the journal Dermatopathology: Practical & Conceptual in 1999 [1], there appeared an article “Have the lessons of Munich been lost on American physicians?” Because of its ethical content, this manuscript was strongly supported and edited by the then founder and editor in chief, the late Dr. A. Bernard Ackerman. During the late 19th and 20th centuries, Europe, including Austria and Germany, were considered to be within the realm of medical excellence. Knowledgeable physicians commonly came for months on end for study and intensive tutorials with the nationally well-known professors in areas such as pathol- ogy and cardiology. These enthusiastic young physicians came from around the world, commonly from countries such as the United States. Emphasis within the introduction of the manuscript, “Have the lesions of Munich been lost on American phy- sicians?” [1] focused on Chamberlain and Halifax, their connection to World War II, and the disastrous effect that appeasement played. In addition, American medicine’s devel- opment is examined regarding the shaping of American medicine with physicians such as Oliver Wendell Holmes (1809-1894) and William Osler (1849-1919), among many others, and the faculty of Johns Hopkins instituting a four- year graduated curriculum, including basic science and specialization. These brilliant alterations and achievements greatly influenced medical institutions throughout the world. Because of the outcry for cheaper medicine, unfortunately, progressive medical excellence did not last in the United States. The deterioration of medicine involved their takeover by a variety of institutions, including government, hospitals and health care facilities, and managed care programs, such as the HMO (health maintenance organization), and the PPO (preferred provider organization), capitation shenanigans and the destructive and corrosive attitude of hospital against hos- pital, doctor against doctor, along with turf battles regarding contracts, all in the name of cheaper medicine. These issues are emboldened to this day. Appeasement has progressed and elevated to wholesale of physicians, as well as elevation of the paramedical personnel to replace the physician. In other words, doctor’s offices and hospital attendance have now become “clinics.” Patients are shuffled in and out of them quickly, oftentimes their rarely spending more than a few minutes with their physician, including a history and physical examination, thus eliminating any kind of meaningful doctor patient relationship. In addition, the sensitive personal relationship between the patient and his/her physicians has been compromised by physicians alternating schedules, and technicians, nurse assistants, nurse/practitio- ners are frequently used to replace the doctor’s personal visit. These medical practitioners are found in doctor’s offices and hospitals, but now shockingly in so-called walk-in clinics, Minute Clinics, drug and grocery stores, often without direct physician supervision. Specialists and knowledgeable trained physicians such as dermatologists, among others, are often bypassed. Unquestionably, specialists are essential in those tricky diagnostic dilemmas such as those with serious conse- quences, for example, distinguishing cutaneous melanocytic lesions and neoplasia, extensive rashes and those with mark- edly elevated fevers, and mild viral eruption versus septicemia. In conclusion, continued use of appeasement in medi- cine is truly demoralizing, devastating, unfortunate and a disaster for medicine and for both patient and physicians. As appeasement continues to grow, there will be progressive loss of astute, accurate medical diagnoses and treatment. Interest Appeasement never works Robert M. Hurwitz1 1 Cutaneous and Maxillofacial Pathology Laboratory PC, Indianapolis, IN, USA Citation: Hurwitz RM. Appeasement never works. Dermatol Pract Concept 2015;5(2):7. http://dx.doi.org/10.5826/dpc.0502a07 Copyright: ©2015 Hurwitz. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Corresponding author: Robert M. Hurwitz, MD, Cutaneous and Maxillofacial Pathology Laboratory PC, 9292 North Meridian Street, Suite 210, Indianapolis, IN, USA. Email: bobbyhur@aol.com 56 Note | Dermatol Pract Concept 2015;5(2):7 and a disregard for the obnoxious concept of appeasement. Appeasement never works! References 1. Hurwitz RM. Have the lessons of Munich been lost on Ameri- can physicians? Dermatopathology: Practical & Conceptual 1999;5(1):7. in students to make a career in medicine as a physician will wane. In essence, appeasement never works! Isn’t it time that physicians get back to practicing medicine, where doctors are actively in contact and in charge of the patient care as well as in the organization of medical and hospital practices? Physicians and patients alike are aware of what is really going on! The time is overdue for a change of complacence