The Challenges of New Practitioners

“What keeps you from moving faster with your clinic time?” I asked. “Honestly,” she said, “I don’t know what I see. I don’t know if I am getting the right diagnosis. It could be so many other things. And if I think it’s the right diagnosis, which of all the treatments is the best? You seem so confident.”

Undoubtedly, healthcare, let alone dermatology, can be daunting in the early years. In fact, with the myriad of new medications for various disease states pouring out into the mix, understanding mechanism-of-actions, side effect profiles, drug contraindications, and more is truly like drinking from the proverbial firehose even for the older warhorses.

Strategies for Improvement What’s an overwhelmed provider supposed to do?

1. Take One Step at a Time First, take the advice of how to eat an elephant: one bite at a time. I have a dedicated slot where I peruse through the most valuable articles from dermatology journals each week and thoughtfully highlight the facts I need to make intelligent assessments, diagnoses, and prescribing.

2. Focus on Weak Areas Second, don’t review what you already know: always hit your weakest spot. Remember that one patient that proved so difficult to care for? Thank them. They made you a better provider and you knew exactly what to do for the next dozen people with the same condition.

3. Embrace Questions and Learning Opportunities Third, don’t shy away from questions from patients and experienced colleagues. Even one suggestion can make for a revelation that turns your paradigm around. I still treasure the times the lightbulb went off for me in conversations.

4. Share Knowledge with Others Fourth, if someone asks you to share what you know, unless you have crippling social anxiety, get up there and tell them what you learned. Explaining it to others puts it into concrete for yourself.

Facing Challenges and Taking a Step Back

Finally, I still face challenges too. I have learned to slow down the moment there is a zebra and take a long breath and start to ferret out a solid history.

A Case of Sporotrichosis An older gentleman was referred to me with a large reddish, tender nodule on the side of his right index finger. It had been treated alternately with many antibiotics for cellulitis and then oral steroids, and even an attempt was made to drain it. Nothing was working.

In my conversation, I asked the man about his hobbies. “Loves his roses,” his wife said, “But he just won’t wear gloves.” The light went on from something I had once read. “Do you get stuck with thorns?” “Sure. In fact, I should mention that this finger gets stuck all the time.”

The diagnosis was sporotrichosis – I had just read about it. He received oral itraconazole from me and completely improved, and started listening to his wife.

Conclusion: The Path to Confidence and Growth

Keep taking small bites every day and thank your challenging patients. You will improve with time and your patient numbers will slowly increase to where your confidence will also shine.

Victor Czerkasij a Master of Science in Nursing from Vanderbilt University (Nashville, TN), Master of Arts and Bachelors from Southern Adventist University (Collegedale, TN), and completed his DNP through Graceland University. He is a member of the Fitzgerald faculty and lectured for Fitzgerald Health Education Associates (FHEA) for nearly 15 years and  edited the dermatology chapter for the NP Certification Exam Preparation volume.  In 2018 he was voted the official “Provider of the House” by the Tennessee State Legislature. A certified family NP with the American Academy of Nurse Practitioners (AANP) licensed for both Tennessee and Georgia, he is the senior provider for Skin Cancer and Cosmetic Dermatology, PC, Chattanooga and Cleveland, TN.

This article is brought to you by Skin, Bones, Hearts & Private Parts, a leading provider of In-Person, Virtual and Online CME for Nurse Practitioners, Registered Nurses, Physician Assistants, and Physicians. Learn more.