Joe MonroeBy: Joe Monroe, MS, PA
When I graduated from PA school in 1978, the emphasis in our educative process was on “serious disease”, thought then to present mostly in inpatient situations or in emergency rooms. By the time I graduated, I was ready to deal with things like the unconscious patient, the patient who had stopped breathing, or who was having a heart attack. Not that I was an expert in those areas, but I had a good understanding of the basic pathophysiologic processes, life support issues, and how to keep the patient alive until a diagnosis was arrived at. I could read chest films, interpret EKGs, and first assist with almost any common surgery. But I had no idea of the struggle I would have with outpatient medicine in general, and dermatologic complaints in particular.
We had had dermatology lectures in school, and I remember thinking what a waste of time that was. “Skin” – how important could that be? You look at it, ask a few questions, throw some medicine at the problem, then move on to something important. Somehow I passed the tests but had no interest in the subject until I graduated and wound up practicing internal medicine in an outpatient setting. Little did I know, literally, about skin, and it showed.
Patients were showing me lesions and expecting me to know what they were! I thought “how the heck should I know?” The same with rashes and symptoms of itching. I was also stunned to discover that almost 25% of all my patients had at least one complaint related to their skin. I had no idea such complaints were that common – why hadn’t anyone told me this in school? I knew absolutely nothing about skin, and it didn’t take long to figure out why that was so: I had not invested one minute in learning about skin, and I had slept-walked my way through the derm lectures in school!
Ok, I thought, I’m a PA, and I have physicians around me who are here to give me advice. My SP in those days was a brilliant infectious disease specialist, but when I went to him for advice about skin, I soon found out he didn’t know any more than I did about everyday skin problems. “Sorry”, he said, “you’re on your own – I never learned anything about skin either. Just do what I do, and send them all to dermatology.” Except it took 3 to 4 months to get a patient in to see a dermatologist. In the meantime, they were my problem.
If you’re in primary care, whether you’re a physician, PA or NP, this situation will sound very familiar to you. In future blogs, I’ll talk about how I dealt with this problem, including concrete, specific tips on how to acquire some basic derm skills.