Commentary

God's Tattoos

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But to my surprise, the patient answered, “No way, man. I didn’t stop treatment because I lost faith in the medicines or the prescribers. I stopped because I realized vitiligo is part of who I am. I think of it as ‘God’s tattoos.’ If He put these spots on me, why should I take them off? I tried and tried, but nothing worked. Maybe it wasn’t meant to. ”

“Fair enough,” I replied. “Let me know if you change your mind.”

But it was my mind, I realized, that needed to be changed. Just like the manmade inked image on his side, this young man sported his vitiligo with pride. My initial supposition was that he had a condition he wanted cured, and that was true—at least as far as the psoriasis was concerned. The vitiligo, though, he viewed not as a disease, but as a positive attribute that helped define who he was.

Each morning, I still play my game of guessing the disorder based on the brief complaint written on the daily appointment schedule. But my differential has broadened, thanks to this man’s unique outlook on psoriasis and vitiligo. I try to keep in mind that while I can give a name to a disorder and treat it, the patient’s perception of the pathology should never be overlooked.

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