Wait, you don't know what Poison Ivy looks like? .... Neither did I.

July 30, 2017

Lakeway Dermatology, the facility I did my dermatology rotation at has two offices, the main office is in Morristown and the second office is in Jefferson City. The second office is mostly ran by Daniel Kachelmyer, PA-C under the supervision of Dr. Brimhall. Although I originally started my rotation in Morristown, I quickly learned that under the guidance of a PA, I would learn more about what I needed to know or what was required of me. There is a huge gap between how much a dermatologist is required to know verses how much a physician assistant that works in dermatology needs to know. Even though I would love to learn about everything in this field because it is truly fascinating, I have to be realistic, my Derm course in PA school probably only lasted a week or two-- there was no way I could build so much on such a weak foundation.... So, I decided to spend the majority of my time with Daniel, the PA in Jefferson City.


My first day in Jeff City, Daniel made me feel like he was so excited to have me. This was a big deal to me.. Sometimes I feel like preceptors don't enjoy the company of students because of the idea that "students only slow you down," well this is definitely not how I felt when I met Daniel. 


When I first met him he greeted me with a smile and shook my hand and said, "it's a pleasure to have you; I look forward to teaching you everything I know." I smiled so big that I think I remember my mouth hurting, it was just so nice to meet someone so genuine and polite. Anyway, I was so ready to start seeing patients with him.


On our first day together we saw a patient with very small, red, inflamed and elevated bumps scattered all over his lower legs. In his history he told us that it started about two years ago when he started playing football. The presentation and the history were classic textbook presentation but of course here I was struggling to figure out what it could possibly be. A couple minutes later, Daniel smiled and said it looks like it could be folliculitis that has been irritated by the pads worn during practice. By this time, I'm smacking my forehead in complete disappointment thinking how could I miss something that simple and unfortunately for me the simple missed diagnoses didn't stop there..


Just a couple days later a patient came in with red bumps that presented in a linear pattern. The bumps were fluid filled and looked very diagnostic for something, but what? Geee, I didn't know. The patient stated the bumps were really itchy and he felt like they were spreading. Of course I felt like there was a million things it could be. Once Daniel noticed that I was struggling he steered me to the right diagnosis when he asked the patient if he was out doing yard work within the last couple of weeks. At this point I felt like I could redeem myself and pretend like I knew it was poison ivy all along.... haha yeah right.. 


Luckily though, Daniel was and has been the most encouraging preceptor I have EVER worked with. After multiple wrong diagnoses, he never made me feel bad or dumb for the questions I asked. Actually, I'm pretty sure his favorite phrase was, "that's a great question." Even when it truly wasn't a good question. Within just a few days, I was starting to diagnose patients correctly left and right, it was a great feeling! Daniel's positive attitude and healthy learning environment made that 40 minute drive to work well worth it! 

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