Earlier this week I had an appointment with the dermatologist for a routine skin cancer screening, and was surprised when the PA (Physician's Assistant, like a Nurse Practitioner with more schooling) came in and didn't introduce himself or anything, just started in on the exam. I happened to know he was a PA because I saw the practitioner profile on the website, and normally I don't mind seeing a PA so it wasn't a big deal to me. He found a few areas of suspicion, as he called them, and as we were discussing whether to biopsy them, he said that some dermatologists would take a less aggressive approach, but he prefers to do the biopsy. Doesn't this sort of imply that he is also a dermatologist? It was on my leg so I let him do it, sort of in the same theory that you don't want your doctor to start your IV because although they can do it, they don't ever do it and therefore don't do it well. Let the nurse or the phlebotomist do it. So I didn't really care that this guy did a small biopsy on my leg but when he told me that he needed to do two additional ones on my face (!!), I wasn't sure I still wanted to go along with the plan. He seemed put off by my questions about how much of a scar would be visible, and said there wouldn't be any real way to predict until he did the procedure, but it would be just a small scar. Just two small scars, actually...on my face! What do you think? Should I let him do the procedure, should I ask for an actual doctor at the same practice, or should I go elsewhere entirely?
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First, I would research and find the difference between a NP and a PA. A PA does not have more schooling than we do. You need to also ask the PA what his credentials are for the procedure that he is wanting to do. How many has he done it? As NPs and PAs, we are trained to biopsy things if it's listed under our agreement with our collaborating MD. Since he works in a dermatologist office, he is very proficient in that type of work or the MD would not let him perform the task. Every person heals differently, so there is no way a MD, PA or NP can tell you in advance how you will scar regardless of what type of training they have. I agree that it was rude not to have introduced himself to you with his title before the exam. I always tell my new patients who I am and what title I hold and what I can do under my license that way they have the option to reschedule with the MD if they are not comfortable with me. None have so far!
I agree with him regarding being slightly aggressive rather than sit back and wait. Too many of my melanoma patients have been misdiagnosed by an MD. I prefer to be better safe than sorry. You should be comfortable with your provider regardless whether they are MD, NP or PA before they touch your face. I hope this helped to ease your mind.
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