John Browning, MD: Medical Errors, Confirmation Bias, and Emerging Therapies in Pediatric Dermatology

John Browning, MD, is a pediatric dermatologist in San Antonio, Texas, an adjunct assistant professor of pediatrics at Baylor College of Medicine, and adjunct faculty at UT Health.

At the 2024 Society for Pediatric Dermatology (SPD) Annual Meeting in Toronto, Ontario, Canada, Browning participated in a panel session titled, "Medical Decision Making - Where Did I Go Wrong?" Browning, alongside Raegan Hunt, MD, PhD, Baylor College of Medicine/Texas Children’s Hospital; and Aimee Smidt, MD, University of New Mexico; shared personal cases of medical decision making that were later analyzed in a talk by Donald Redelmeier, MD, University of Toronto.

Browning spoke with Dermatology Times to discuss the highlights of his involvement in the panel discussion and the exciting pediatric dermatology pipeline ahead.

"I do think it's helpful to have this ability to to be vulnerable, to get feedback as well, and to learn about why we might make some of these errors," Browning said.

Transcript

John Browning, MD: My name is John Browning. I'm a pediatric dermatologist in San Antonio, Texas. I'm adjunct faculty at UT Health, and I spend my time in clinic as well as working with residents, teaching, and seeing clinical research patients.

Dermatology Times: What are key highlights and takeaways from your panel session?

Browning: This was a panel of 3 of us, and we were asked to share medical errors that we experienced in the course of our career. It was kind of a humbling proposition being asked to be vulnerable, but at the same time, this was a really great audience to do that, because it is like a family. Many of us have been coming to these meetings for many, many years, and so it's just a great opportunity to not just to share this case, but to really dialogue about it. I think that there was a lot of kind of shared experience in the audience, that many people, they were kind and gracious and said, "Oh, yeah, we we all do that all the time." I do think it's helpful to have this ability to to be vulnerable, to get feedback as well, and to learn about why we might make some of these errors, whether it's a delay in diagnosis, making the wrong diagnosis.

In my particular case, I shared a story where a patient saw someone else in my practice and went down one treatment pathway, one diagnosis, which actually had been a correct diagnosis at the beginning, but then with worsening, a biopsy was done and it showed really the incorrect diagnosis. Rather than going back and doing another biopsy and reevaluating when treatment was failing, we just stayed on that same path, really much longer than would have been, and I did take over care. I'm actually the one who had repeated the biopsy that ultimately showed the true diagnosis, but this was after many visits of just not really arriving at the the right diagnosis.

It was good to learn about confirmation bias and how we can rely on something early on that we want to confirm our decision making, and we want to hold on to that, rather than to reevaluate. It's helpful that Dr Redelmeier, who was the speaker after our 3 cases, talked about how it's helpful to have someone that you trust, maybe in your practice, or a colleague in another group or another academic center, that can play devil's advocate and can kind of see things from a different perspective. I felt that that was very helpful.

Dermatology Times: What is new or upcoming in pediatric dermatology that excites you?

Browning: As a clinical researcher as well as a clinician, I get to work with new therapies and new drugs before they hit the market. It's very exciting, and there's a new topical medication that's going to get an additional approval for atopic dermatitis, hopefully later this year, called tapinarof. I'm really excited that hopefully that will ultimately get approved. It's looking very hopeful. I'm also just excited about the new therapies that are getting approved for alopecia areata, and hopefully, eventually, for vitiligo. We've got some some trials with vitiligo for kids, which are long overdue.

[Transcript has been edited for clarity.]