Mona Shahriari, MD, FAAD

Murina believes adequate clinical hours remain essential for building competence, even as duty-hour and wellness policies evolve.

AI could ease documentation and administrative burdens so physicians can focus on patient care and teaching.

Prospective physicians should expect setbacks, trust mentors, and stay open to alternate pathways.

podcast, host Mona Shahriari, MD, associate clinical professor of 

 at Yale University and a practicing dermatologist in Connecticut, is joined by Andrea Murina, MD, an associate professor of dermatology and the program director at Tulane University School of Medicine in New Orleans, Louisiana.

Together they explore a question many physicians quietly ask: knowing what they know now, would they still recommend medicine to someone they love? For Murina, a general dermatologist and mother of 3, the question is far from theoretical. Her oldest son has expressed interest in pursuing medicine, and more recently so have his 2 younger brothers.

The Medical Sisterhood: Is Becoming a Doctor Still Worth It? With Andrea Murina, MD

The Medical Sisterhood: Is Becoming a Doctor Still Worth It?

Murina also oversees more than 400 residents and fellows across the university's graduate medical education programs. She describes an initial sinking feeling at her son's news, rooted in memories of the effort, uncertainty, and stress required to reach medical school and residency. She came from a nonmedical background and entered training with little guidance. Viewing the system through a parent's eyes, she notes, has made her more critical of how medical education is structured and more reflective about how she approaches learners.

Ultimately, she concludes that the struggle is often where the meaning of the profession is found. She would choose medicine again despite years of imposter syndrome and the challenge of overcoming a tendency to faint during procedures. She also highlights the unexpected variety of her career, from teaching and hospital committees to journal reviewing and creative presentations.

How Should Residency Programs Balance Duty Hours With Clinical Competence?

Murina argues there is a limit to how far duty hours can be restricted without leaving trainees underprepared. She compares residency to training for a marathon or an Olympic event and emphasizes that competence and confidence come only through practice.

In her view, the goal of training is to produce physicians who may not know every answer but know how to find one without fear or panic. Shahriari echoes this point, recalling a residency interview in which she was asked to estimate a figure she could not possibly know, a test of problem-solving rather than recall.

At the same time, Murina rejects the long-standing expectation that physicians work while ill. She supports Accreditation Council for Graduate Medical Education requirements allowing residents and fellows to attend health care appointments, including mental health visits, as needed. She notes that physicians who fail to build these habits during training rarely adopt them later, which contributes to poor health outcomes across the profession. She encourages full use of vacation time but cautions against using sick days simply because they are available.

Can AI Reduce Administrative Burden for Dermatologists?

Murina describes herself as cautiously optimistic about artificial intelligence (AI). She sees particular potential in offloading documentation, billing, and prior authorizations, which she views as tasks below physicians' level of expertise and key contributors to burnout. Even with AI scribes, she notes that managing callbacks and messages across 3 clinic locations remains a significant burden. She hopes future tools will free more time for patient care, shared decision-making, and teaching. She also anticipates that dermatology subspecialties may evolve over the next decade, potentially creating new technology-driven roles.

What Should Prospective Physicians Know Before Choosing Medicine?

Addressing generational differences, Murina rejects the notion that younger physicians lack work ethic and frames the issue as one of expectation management. Both clinicians acknowledge a tendency toward people-pleasing and difficulty disconnecting on vacation. They agree that setting boundaries with patients supports long-term practice. For prospective physicians, Murina stresses normalizing failure, remaining open to alternate pathways, and trusting guidance from mentors.

She also acknowledges that admissions and dermatology residency applications have grown dramatically more competitive. Shahriari closes by suggesting the key question for the next generation is not whether to become a physician, but what kind of physician to become and what kind of life medicine should fit into.

Editor’s note: Neither speaker had any relevant disclosures of note. This episode was summarized with the help of AI tools.

Want to join The Medical Sisterhood community? Click here to join our LinkedIn Group!

Podcasts

Andrea Murina, MD, weighs whether she would recommend medicine to her own children amid AI, physician burnout, and evolving residency training standards.

Building trust with patients who have diverse skin tones, and addressing 

 as a condition that reaches beyond the skin, were the focus of this segment of the most recent 

featuring Jennifer Soung, MD, and Mona Shahriari, MD.

Soung is known for her work as a board-certified dermatologist and as the director of clinical research at Southern California Dermatology in Santa Ana, California. Shahriari is an associate clinical professor of dermatology at Yale University and the host of HCPLive’s 

 podcast. Both spoke in this new episode of Skin of Colorsavvy, a podcast hosted by 

Why Trust and Timing Shape Psoriasis Outcomes in Skin of Color

Why Does Early Psoriasis Diagnosis Matter?

Shahriari opened by asking how clinicians can get patients into the office sooner for an accurate diagnosis, noting that delayed diagnosis in patients with diverse skin tones can leave disease harder to treat and less likely to reach remission. Soung said the current health care system is largely built around catastrophic care, responding once a patient has extensive body surface area involvement or can no longer work, rather than intervening early. She noted that early treatment improves outcomes across skin tones, but patients with diverse skin tones often face additional barriers to access and may distrust the health care system.

Soung said addressing that gap starts with meeting patients in their communities and building trust through cultural curiosity, including simple open-ended questions about a patient's skincare routines or cultural background. She described using telehealth in her own practice to reduce travel time and time away from work for patients, calling personalized, culturally sensitive care the future of the specialty.

How Can Clinicians Build Trust With Diverse Patient Populations?

Shahriari said patients increasingly assume a shared background signals expertise in treating their skin, recalling a patient who told her she must understand his skin because she looked like him. She said that assumption can be leveraged productively, but clinicians without shared backgrounds can build similar trust through curiosity and cultural sensitivity rather than assumed cultural knowledge. Both agreed that as demographics shift, patients with diverse skin tones will represent a growing share of dermatology practices, making early, trust-based diagnosis increasingly important to patient outcomes.

What Psychosocial Burdens Should Clinicians Watch For?

Shahriari asked how Soung addresses the psychosocial impact of psoriasis and connects patients with mental health support when needed. Soung said she now opens visits by asking patients how psoriasis has affected them, a question that can prompt strong emotional responses, including embarrassment and social stigma tied to visible plaques. She described a patient in his mid-30s who avoided removing his shirt at the beach for years until a stranger, noticing his discomfort, urged him to see a dermatologist.

Soung said moments like that reflect why many clinicians entered medicine, the ability to help patients feel normal again through connection and collaboration. Shahriari said she sometimes splits diagnosis and broader psoriasis-related counseling across separate visits so patients are not overwhelmed by comorbidity discussions on day one, an approach her schedule as a practice owner allows her the flexibility to offer.

How Should Treatment Plans Account for Patient Routines?

Soung noted that patients are often reluctant to admit dissatisfaction with an otherwise effective treatment unless directly asked, and that she has learned the most by asking patients at follow-up visits whether they are happy with their treatment. Shahriari raised the example of scalp psoriasis treatments that require daily shampoo use, noting that regimen is often unrealistic for patients with afro-textured or tightly coiled hair, and asked how treatment routes can better match a patient's daily routine and long-term adherence. Both agreed that efficacy alone does not determine whether a patient continues a treatment, and that the confidence and trust built during a visit often shape treatment success as much as the medication itself.

Editor's note: This summary was edited with the help of AI tools.

Soung J, Shahriari M. Skin of Color Savvy: Advice on Diagnosing Psoriasis in Diverse Skin Tones. HCPLive. August 26, 2026. Accessed September 22, 2026. 

https://www.hcplive.com/view/skin-color-savvy-advice-diagnosing-psoriasis-diverse-skin-tones

Videos

Jennifer Soung, MD, and Mona Shahriari, MD, discuss trust-building, psychosocial burden, and treatment fit in psoriasis care for diverse skin tones.

Erythema, scale texture, and itch can present differently in psoriasis with more pigmented skin, often leading to underestimated severity or misdiagnosis as atopic dermatitis.

Standard severity measures such as PASI, PGA, and IGA don't account for post-inflammatory dyspigmentation, which patients may view as a sign that treatment failed.

Delayed or incorrect diagnosis can carry psychosocial and financial consequences beyond prolonged itching and pain.

 can look markedly different in patients with more melanin in their skin, and those differences are often missed using diagnostic tools and severity scores built around lighter skin tones, according to a spinoff segment of the 

 featuring Jennifer Soung, MD, and Mona Shahriari, MD.

Soung, a psoriasis specialist, said her interest in the condition began in medical school through research with Mark Lebwohl, MD, and grew alongside an early focus on the immunology behind biologic therapies. She trained in New York City specifically to gain exposure to a wide range of skin tones and racial and ethnic backgrounds, and she noted a preference for the term "diverse skin tones" over "skin of color," since disease presentation is ultimately a matter of skin biology rather than race or ethnicity alone.

Jennifer Soung, MD, and Mona Shahriari, MD, discuss diagnosing psoriasis in diverse skin tones and why severity scores overlook dyspigmentation.

Tips for Clinicians Diagnosing Patients with Diverse Skin Types

How Does Psoriasis Present Differently in Richly Pigmented Skin Types?

Shahriari asked Soung for visual diagnostic tips clinicians could apply in practice. Soung explained that erythema in psoriasis often appears less bright red in more pigmented skin, sometimes presenting as a subtle or violaceous tone that can lead physicians to underestimate disease severity, an effect that can persist even in clinical photographs taken under standard lighting. Plaques may also be thicker, and the classic silvery scale associated with psoriasis can instead appear micaceous or keratotic.

Itch tends to be more pronounced in some patients, and Soung described a case in which excoriation from itching made a psoriasis plaque resemble chronic atopic dermatitis. She recommended biopsy in cases of diagnostic uncertainty, along with dermoscopy, which Shahriari noted can use polarized light to help distinguish erythema from non-erythema and pigment from non-pigment change. Both physicians agreed that a poor response to a highly effective biologic or advanced systemic therapy should prompt clinicians to revisit the diagnosis.

Why Isn't Dyspigmentation Included in Psoriasis Severity Scores?

Both speakers pointed to post-inflammatory hyperpigmentation and hypopigmentation as a major, and frequently overlooked, part of the patient experience. Shahriari said patients often report that a biologic has not worked even after plaques have fully cleared, because residual dark or light marks remain visible to them. Soung noted that standard tools such as the Psoriasis Area and Severity Index and the Physician Global Assessment or Investigator Global Assessment were developed using white skin and do not account for dyspigmentation, raising the question of whether these measures, or clinical trial endpoints more broadly, should be revised to reflect that aspect of disease burden.

What Happens When Psoriasis Is Misdiagnosed?

Shahriari and Soung agreed that delayed or incorrect diagnosis compounds harm well beyond prolonged itching and pain. Soung described the case of a Vietnamese Middle Eastern ICU nurse who had been treated for atopic dermatitis with an interleukin-4/13 inhibitor for a year; the medication controlled her itch but not her skin lesions, and after a lapse in treatment, a well-demarcated silvery plaque on an area she could no longer scratch pointed to a psoriasis diagnosis that had been missed.

Soung said consequences of delayed diagnosis in this population can extend to psychosocial and financial harm, including job loss in cases where visible plaques affect a patient's career. Shahriari said the broader lesson she shares with residents is to broaden their visual expectations of disease presentation, rather than relying on textbook descriptions built around a narrower range of skin tones.

Skin of Color Savvy: The Art and Science of Treating Patients of Color

Psoriasis often presents with less visible erythema and thicker, more keratotic scale in darker skin tones, which can lead to underestimated severity or misdiagnosis as atopic dermatitis.

Standard severity scoring systems like PASI and PGA don't capture post-inflammatory dyspigmentation, a lasting concern for many patients even after psoriasis clears.

Soung emphasized asking open-ended questions and limiting treatment choices to two options at a time to improve adherence and long-term trust.

 in patients with diverse skin tones requires a different visual approach and a deeper conversation about disease burden.

This topic was explored in a discussion between Jennifer Soung, MD, board-certified dermatologist and director of clinical research at Southern California Dermatology in Santa Ana, California, and Mona Shahriari, MD, associate clinical professor of dermatology at Yale University, on the latest iteration of 

Skin of Color Savvy: The Art and Science of Treating Patients of Color, 

Skin of Color Savvy: Advice on Diagnosing Psoriasis in Diverse Skin Tones

How Does Psoriasis Present Differently in Melanin-Rich Skin?

In this podcast episode, Soung explained that psoriasis often presents with less pronounced erythema in darker skin tones,which can lead clinicians to underestimate disease severity. She noted that plaques may appear thicker with more keratotic scale, and that itch can sometimes overshadow classic plaque appearance, occasionally leading to misdiagnosis as atopic dermatitis.

Both physicians said biopsy can be a valuable tool when diagnosis is uncertain, particularly since post-inflammatory dyspigmentation, a common and often distressing feature for patients with skin of color, is not captured by standard severity scoring systems such as the PASI or PGA.

Why Is Early Diagnosis and Treatment Critical for Patients of Color?

Soung and Shahriari discussed how delayed or missed diagnoses can compound psoriasis' physical, psychosocial, and even financial impact, particularly when disease affects visible areas of skin. Soung attributed some of these delays to systemic barriers, including limited health care access and mistrust among diverse populations, and said addressing these gaps requires meeting patients in their communities, using tools like telehealth, and approaching cultural differences with curiosity rather than assumption.

How Can Dermatologists Improve Treatment Adherence and Trust?

The conversation also addressed how psychosocial burden and treatment preference shape long-term outcomes. Soung said asking patients open-ended questions about how their condition affects their life often surfaces concerns that go unaddressed in a typical visit, while giving patients only two treatment options at a time, rather than overwhelming them with the full range of available therapies, helps guide decision-making.

Both physicians emphasized that efficacy alone does not determine whether a patient continues treatment, and that factors like route of administration, safety concerns, and lifestyle fit, particularly for patients managing scalp psoriasis with textured hair, must be part of the conversation. Soung closed by encouraging clinicians to approach care for patients with skin of color with openness and consistency, framing it as an area of dermatology where ongoing dialogue continues to improve outcomes.

To learn more about SOCS’s programs and initiatives, visit 

Editor’s note: This episode was summarized with the help of AI tools. Shahriari and Soung had no relevant disclosures of note.

Gkini MA, Nakamura M, Alexis AF, et al. Psoriasis in People With Skin of Color: An Evidence-Based Update. Int J Dermatol. 2025 Apr;64(4):667-677. 

. Epub 2025 Jan 31. PMID: 39887710; PMCID: PMC11931096.

Jennifer Soung, MD, and Mona Shahriari, MD, discuss diagnosing psoriasis in diverse skin tones and building patient trust and adherence.

Mona Shahriari, MD, FAAD

Articles