“Attitude is everything” is Dr. Tim Berger’s motto—obviously, words he has lived by. Despite an unplanned path, his extraordinary curiosity about whatever he encounters has molded him into a leader in dermatology education. He is also an expert on itch and HIV dermatoses, and is a co-author of Andrews’ Diseases of the Skin with Dr. William James of Penn.
When did you first become interested in dermatology?
Bob Freeman who did dermatopathology at UT Southwestern was where I first heard of dermatology in medical school, but he was misleading, because he said “There are only 500 diagnoses in the skin, and you learn over 2,000 new terms in anatomy alone–so anybody can learn 500 diseases.” So when I heard that, I thought ‘That’s for me.’ but of course, it’s more complex than that, because there are over 5,000 different cutaneous diseases.
With so many diseases to choose from, how did you discover your niche?
First of all, I never planned anything and most of my path has occurred through happenstance or good luck. It turns out that during (residency) interview season, I went to go visit my roommate from Rice who was living in the Bay Area, because I already knew I was going into the military and didn’t have to interview for an internship. When I was visiting him, I learned there was an Army Hospital (Letterman) in San Francisco, which I didn’t even know. So, I went over to visit and met the people in medicine, and they ended up matching me, and then I met Dick Odom (Richard B. Odom) during my intern year, and he took me as a dermatology resident. So, my roommate from college is basically how I kind of became the next Dick Odom.
During dermatology residency, I had thought about being a pathologist, and in our senior year we were allowed to do 3 months at the AFIP (Armed Forces Institute of Pathology), so I did that. Then I was sent to Korea, and I knew if I was going there, I’d better know a lot about infectious diseases, syphilis, etc.. Then I returned to do my fellowship in dermpath, and when I finished I worked with Bill (William James) at Walter Reed for a few years, then when Dick retired from Letterman I returned to San Francisco. When my time in the Army was up, I joined UCSF because Letterman was affiliated and I taught there, and Bruce offered me a job.
In the early years, at UCSF, it was 1987, we started seeing the world of AIDS and I thought “well I’d better figure this out” One out of every 4 patients in our clinic was HIV+. We had the largest HIV clinic in the United States at that time. While there were more HIV infected individuals in New York, they didn’t all go to one hospital. Here, they all came to San Francisco General. Seeing patients with HIV disease I learned a lot of other medicine. At that time, I was doing the general dermatology and the derm surgery, because at one time I thought I was going to be a Mohs surgeon, but then I started to get interested in medical student education and I realized I was a better clinician than I was a dermatopathologist, so I decided to focus on clinical dermatology. So it was overall kind a meandering track that ended me up in the right place.
How do you keep your flow and what are your new sources of inspiration?
I’ve been lucky because Bruce is such a wonderful chair, kind of like Kim (Yancey of UT Southwestern) they’re both such great chairs because they have this philosophy which is “let good people do what they are interested in.”
As long as faculty are accountable for what the department is needing them to do, people will find their own interests.
Which for me was HIV disease for 10 years, and then I became the program director and got involved in the medical student online derm curriculum (now the AAD Basic Derm Curriculum), then when Dick retired, I got involved with complex medical derm consultative work, then I started to see a bunch of older itchy people and had to figure that out. So, every 5 years, I’ve had the opportunity to kind of morph and become interested in something else. It’s kind of been whatever’s been in front of me that I need to sort of understand—that’s what I become involved in.
What qualities do you most value in your residents?
I like character more than content—a key trait is whether people can work collaboratively. The key to academic success is now collaborative work. It used to be that you could be by yourself, off alone somewhere, like Mike Bishop would go into a lab and come out an go ‘Oh, I found an oncogene’ because he had an idea that maybe genes that make fetuses grow get reactivated in cancer. That kind of thing doesn’t happen that much anymore, it’s groups and teams, and in clinical settings we work in teams too, and we look for positive attitude and a cooperative personality, the kind of people that come to clinic and are smiling every day.
What phrases do you say to your residents that you hope they remember forever, so that someday when they are in practice many years from now—they will hear your voice in their heads?
Yes—there are a couple. “First, if there is something you think is a disease, but it’s atypical, then that disease may be associated with a medication or some other exogenous factor.” And secondly, “The patient always knows what they have, and our job is to listen to their history and translate that into medicine.”
If you could meet any dermatologist from the past, who would it be and why?
Well, there are some dermatologists that I’ve met already, that are my heros, like Sam Moschella, because Sam was the first academic military dermatologist, because he went from the Navy to the Harvard program, and so those of us in the military that aspired to a career in academics, that was a huge inspiration.
I would have liked to meet Dr. Pillsbury (Donald M. Pillsbury) because he wrote the first dermatology book for medics, because he was the dermatology consultant for the US Troops in Europe (during WWII). Marion Sulzberger was the consultant for the Pacific theater at that time. He had many intuitive ideas about dermatology and I would have liked to know them both better, because it would have given me a better sense of my own history regarding dermatology training in the military.
What’s your motto? “Attitude is everything.” I tell this to my kids all the time and my 15-year-old is like “oh, whatever…” which is kind of the anti-attitude.
You can help save the moulages and have Dr. Berger carry your books for you with his Burgundy Berger Bag.