Rahul Nanda, MD shares his preceptorship experience with Joel L. Cohen, MD, FAAD, FACMS
I had an incredible week with the man who goes by many names: “Joel PubMed Cohen,” “Data Dude”, or what most call him by: “Safety Joel.” This report highlights my one-week elective experience with Dr. Joel Cohen at the AboutSkin clinic in Greenwood Village, Colorado, which was easily one of the best weeks of my residency. Dr. Cohen is a distinguished dermatologist known for his expertise in the field of aesthetics and procedural dermatology, as well as his commitment to evidence-based and safety-oriented practice. During the elective, I had the opportunity to observe and actively engage in discussions in his clinic while also pursuing research endeavors. I gained valuable insights into procedural dermatology in a clinic-based setting, where patient-centered care is a core value of the practice.
The clinic stood out for its impeccable organization and emphasis on safety and teamwork. What was most impressive is the attention to safety accorded by him and his team. The following are examples of protocols followed in the clinic to avoid adverse events (for the patients and providers): Dr. Cohen consistently ensured that everyone in the laser room had appropriate eyewear prior to firing, biopsy specimens were verified twice to ensure the correct patient labeling, and meticulous skin preparation and setup were done to minimize cross-contamination during neurotoxin and filler injections, to name a few. Notably, not only were rigorous protocols in place, but safety designs were intentionally curated as part of the design and setup of the clinic space. For example, during PRP treatments, a portable sharps container gets placed adjacent to the patient to minimize risk of needle stick injuries, and patients are only booked for PRP in rooms containing a centrifuge, such that only the patient’s tube is spinning, and the patient’s blood does not leave the room.
His clinical expertise during patient encounters was really a highlight for me, where his comprehensive approach to aesthetic dermatology really stood out. Throughout the week, I observed a range of procedures, from neuromodulators to soft tissue augmentation and energy-based devices, in addition to aesthetic consultations. All the recommendations and interventions proposed were rooted in science. He would make sure to provide relevant articles for his patients demonstrating the clinical efficacy of the proposed interventions, along with showing them photographic examples of what they could expect in terms of improvement. He is also very dedicated to patient-centered care, where he takes the time to listen attentively to each patient's concerns and expectations. Even when consultations took longer than anticipated, he never rushed the patient, making sure to address all their questions.
We also saw many interesting cases during the week: an accidental gravel tattoo with improvement following Q-switched and ablative fractional laser, spontaneous oxidation of a lip tattoo improved with fractional laser, and filler hypersensitivity reaction following suspected contact dermatitis to a hypochlorous acid product, among other uncommon presentations. Even for simple cases, he made sure I saw with my own eyes the improvement that occurs following interventions. For example, he had a patient present in follow-up so I could see how quickly PDL improves iatrogenic bruising. Not only were there great cases, but I also valued his approach to explaining complications to patients. I recall a case of a patient who had booked a consult at his clinic after undergoing infraorbital filler by another provider, noticing a bluish discoloration under the eyes. After diagnosing Tyndall phenomenon, he tactfully explained the mechanism of the complication to her, both from the physical optics perspective and in relation to muscle movement and superficial filler migration. The different options were explained to her, and after shared decision-making, she opted to partially dissolve the filler with hyaluronidase. We called the patient two days later and she was thrilled, as the discoloration had resolved.
Dr. Cohen practices a holistic approach to managing patients, addressing not only cosmetic procedures but also lifestyle interventions to target specific concerns. For example, we saw a patient together with melasma, where he not only discussed laser options, but also discussed at length: hormonal factors, medications such as tranexamic acid, the importance of sun avoidance and shade seeking, and the role of visible light in exacerbating pigmentary disorders. He provided specific options for tinted sunscreens with targeted ingredients such as iron oxide. In fact, we saw many such patients that came in for a cosmetic assessment but ended up having dermatologic issues requiring medical or surgical intervention. As examples, we saw: a suspected squamous cell carcinoma requiring biopsy, acute onset cutaneous small-vessel vasculitis requiring workup, and multiple cases of alopecia requiring diagnostic assessment, among others. This really highlights the importance of dermatologists being at the forefront of procedural dermatology, where our expertise in medical and surgical dermatology is the backbone for accurate assessments and appropriate interventions for skin pathologies.
I was also provided mentorship by Dr. Cohen in research endeavors. He actively engaged me in brainstorming sessions, guiding me through the process of formulating and working through ideas that bridged clinical observations with potential research questions to better frame my reports. Throughout the week, with his supervision, we worked on several articles, of which two are soon to be submitted for publication, and I plan on continuing to work on projects with him.
In terms of my personal experience, Dr. Cohen not only made me feel like an integral part of his clinical team but also extended his hospitality outside the professional realm. Within the clinical setting, he made sure to introduce me to each of his patients and other staff members, creating an inclusive environment where I felt welcomed. Beyond the clinic, Dr. Cohen's thoughtfulness continued. His wife, Mrs. Dr. Cohen, packed lunch for me daily, and they invited me to dinner with their family, providing an opportunity for us to get to know each other outside of medicine. Additionally, he took me to The Goo Goo Dolls concert, highlighting his commitment to go above and beyond for his preceptees. These gestures really highlight his genuine interest in developing a strong relationship with his mentees.
In conclusion, my one-week elective at AboutSkin was nothing short of exceptional. His clinic's emphasis on teamwork, safety protocols, and patient-centered evidence-based care are things that I will take away from this elective. More than anything, I am extremely grateful for this opportunity and for having gained Dr. Cohen as a mentor and as a friend. I hope others, too, will be able to benefit from his kindness, generosity, and mentorship, as I have.