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“PAs Can’t Learn Dermatology”

by Joe Monroe, PA-C
by Joe Monroe, MPAS, PA

After graduation from PA school, I’m in internal medicine, having to confront the reality of how little I knew about dermatology and skin-related topics, and how utterly common those complaints were. Worse yet, there was no one who could help me. None of my colleagues knew much derm, and getting my patients in to see a dermatologist took months at that time. I could obfuscate only so much with these patients on the subject of their skin, and I could tell they could tell how little I knew. I asked around about how to learn more on the subject, and someone suggested I shadow a dermatologist. Now there was a brilliant idea – spend a few hours with them, and I’d be off and running.
So I called the dermatologist in our clinic and asked him. He quickly threw cold water on that hot idea. “Joe” he said wearily, “you’re a PA. You haven’t even been to medical school, let alone a dermatology residency. PAs can’t learn dermatology – it’s far too difficult for the likes of you. Just send everything to us.” I was so young and so naïve I believed what he said. That’s how it was in those days. Some things could only be done by someone with an M and a D behind their name. I moped along for a while, stuck in this awkward place, until one day, about 1982, a patient came along who was to change my professional and personal life.
This 25 year-old man came in and quickly showed me an outrageous rash covering most of his trunk with large, round uniformly scaly lesions ranging in size from 1 – 4 cm in diameter. “It started several weeks ago with this lesion on my chest, which faded but now I’m getting more! My wife kicked me out of the bedroom because she’s sure I have “ringworm”. This has thrown our lives into complete turmoil.”
Proudly, I went to get my supervising physician (SP), already rehearsing my announcement of having a patient with the mother of all fungal infections. All I wanted from him was confirmation of the obvious. He took one look at the patient, turned to me and said “you have some work to do in dermatology, don’t you? “
Out of the patient’s hearing, he patiently told me about a common dermatologic entity called pityriasis rosea (PR), caused by a harmless virus, showing me a photo and text in his dermatology book.
“Go show this photo to the patient and read him the part where it says he’s going to be ok, then come back and we’ll talk some more.”
I did as he asked, part of me still wanting to argue for the fungal diagnosis, but knowing he was right. How could I argue, me who had never even heard of PR, let alone know how it looks and how it presents. In my mind, I had hit rock bottom. I had clearly demonstrated how little derm I knew, and worse yet, had no idea how correct the problem. I didn’t know it yet, but I had reached a critical point in my medical career: knowing how little I knew. The conversation I was to have with my SP was to change all that.

See Joe speak this June in Walt Disney World.