In a time when epidemiology is on the front pages, other medical specialties also are fighting pandemic battles daily, with quiet yet intense determination. As a physician assistant (PA) in dermatology, I am continually learning new ways to provide patient care while adhering to strict COVID-19 protocols.
Adjusting Patient Load
At the University of Texas (UT) Southwestern Medical Center in Dallas, I typically see patients 6 to 7 half-days per week, doing skin cancer screenings and treating drug rashes, psoriasis, acne, etc. At the onset of the pandemic, in part to ensure we had enough protective gear, we removed the general cancer screenings from our clinic roster to reduce our in-clinic load, but we continued to see a full complement of more urgent patients. To best accommodate those patients, we made some of the same basic changes to patient flow as many other health care facilities, such as reducing waiting area seating and suspending obtaining a full panel of vitals. We try to have as few staff members interacting with a patient as possible while still providing quality care.
In June, we added general skin cancer screenings back to our clinic but there was a 2.5-month backlog of patients whose general screening appointments were canceled during the beginning of the pandemic. As a result, our volume increased to 110% of our pre-pandemic patient load. This created a critical need for additional infection control. It also increased the stress of patient interaction and tension to an already overtaxed staff. Our university system protocol required face shields and N95 masks be worn throughout the day, but dermatology is still a hands-on practice. I need to be able to see and touch my patients while taking all necessary precautions for their safety and for mine.
Assuming More Responsibilities
We do not have nurse practitioners (NPs) in our department, but the six PAs were all asked to take on additional responsibilities to assist the nurses with phone calls, refill requests, and other duties. While it added to the administrative workload, we are striving to create a more informed patient interaction by providing a higher level of clinical knowledge and hopefully resolve issues more quickly.
Adopting Telehealth Options
Like many other health care systems, our hospital system had telehealth capability, but it had not yet been deployed to the dermatology department. We went through a rapid training regimen to be able to offer the option to our patients. As many of our patients travel a considerable distance to receive the expertise of an academic medical center, teledermatology has been incredibly helpful and convenient for initial consultations and follow- up appointments. We reduce the time patients may need to take away from their own lives to travel as well reduce the exposure risk of our entire staff and other patients who need to be in the exam room for more emergent care.
However, in-person appointments are still so important for overall patient care, as telemedicine is not an appropriate solution for routine dermatologic care such as full-body examinations. The specialty also is unique in that some things—procedures for biopsy, cryotherapy, electrodesiccation and curettage, and others to treat special skin cancers—must be done in office. There simply is no replacement for procedural care than the in-office visit.
Where the strength of telehealth lies is the ongoing management of acne, psoriasis, and other routine conditions. For example, patients who are part of the iPLEDGE system require ongoing monthly check-ins which we can now do virtually. With teledermatology, we decrease the appointment time and exposure for the patient, and it also helps us as providers to be more efficient without having to use and then clean an exam room.
Accessing Online Resources
Finding efficiencies resonates as a theme for everyone in our practice. As a PA, I have found it especially helpful throughout this trying time to access relevant remote resources to stay up- dated on the latest best practices. Because we cannot attend conferences in person, we have to find ways to continue remote learning and get additional CME. I enjoyed being able to participate in virtual CME and stretch my CME dollars because I did not have to pay for flights or hotel. I attended my state organization, the Texas Academy of Physician Assistant (TAPA), Spring Annual virtual CME conference, and this was a great way to get CME and network with local PAs.
Another example is POCN, which provides resources for PAs and NPs with knowledge on how to practically care for patients, navigate a changing health care system, network with other providers facing similar struggles, and use novel ways to approach challenges by learning from other advanced practice clinicians. I have also read articles and attended webinars to help me grow both personally and professionally through a forum that is focused on PAs and NPs. The platform offers free case studies and practice questions to prepare for board recertification and also offers free CME. It is like having a practical toolkit to help guide us through this trying time and beyond.
As dermatology professionals continue to search for the best ways to treat patients while protecting them and our own safety, I have learned to embrace my new responsibilities as well as innovative ways to support my department and my personal growth.
Ms Griffith is a dermatology PA at the UT Southwestern Medical Center in Dallas and earned her Masters of Physician Assistant Studies from UT Southwestern Medical Center. She is the co-creator of a high-risk skin cancer transplant clinic for patients who are immunosuppressed after solid organ or bone marrow transplant. She also practices general adult medical dermatology. Ms Griffith is the grand rounds editor for the Journal of Dermatology Physician Assistants and is a guest lecturer in the UT Southwestern PA program and a lecturer at local, regional, and national conferences. She is a member of TAPA, the Society for Dermatology Physician Assistants, and the American Academy of Physician Assistants. She was awarded the UT Southwestern’s PA of the year in 2017.
