"Real Doctor"

Even though Cosmetic Doctor likes to see primarily cosmetic "patients" he still sees mainly medical patients, since this is before anything else a medical dermatology practice. I can tell that he doesn't like seeing medical patients though, especially pediatric patients. This is a little odd since the practice specializes in pediatrics, but nonetheless this is where he decided to work. Fair enough though, since Boss Doctor is board certified in Peds Derm, so I guess not all Derms would handle kids as well as him.

Quick example of this:
We get many children with Molluscum Contagiosum which Boss Doctor will always attempt to treat. The condition is self-limiting, but we'll try to move it along by using a blistering agent like Cantherone or liquid nitrogen. The Cantherone treatment is immediately painless, but the kids often freak out on us cause they're generally very young. If it becomes too much of a struggle then Boss Doctor just lets it go and gives them a topical that is slower acting but normally less traumatic.

Cosmetic Doctor has been presented with this situation an inordinate number of times lately. How does he handle the situation? By telling parents that pediatric derms generally don't treat it. I'm not sure how true that is since both Boss Doctor and the PAs will attempt treatment every single time. There was one really bad situation where the child was screaming uncontrollably and the parents just weren't convincing us that they wanted us to continue, even though they told us to go ahead. Cosmetic Doctor more or less froze during the situation. At one point I had to interject so that the parents and doctor would stop staring at each other with blank expressions.

Anyway... Fine he's not comfortable treating kids. Pediatric derm isn't his thing, but surely general derm is something he could handle. So a psoriasis patient came in with a history of failing topical treatments, but being successful with biologics in our practice. The patient had to go off the biologics because of insurance problems, but could now continue. Well at least he could of continued if Cosmetic Doctor hadn't replied to his request with, "I haven't prescribed biologics in years and am not comfortable prescribing that." Excuse me?!?!?! THIS IS STANDARD DERMATOLOGY!!! HAVEN'T PRESCRIBED IN YEARS?!?! THERE IS NO WAY YOU COULD BE MORE THAN 5 YEARS OUT OF RESIDENCY!!!

Boss Doctor's verbal reaction to this - "What? Isn't he a real doctor?"

How did we resolve the situation? Referred the patient to the 1.5 years of experience PA that is comfortable handling biologic patients.

Let this be a lesson to all the asshole physicians I've been reading lately who say P.A.s aren't capable of the same level of care as Board Certified physicians. P.A.s are totally capable of being trained to the same standard as board certified physicians. I don't even want to know how Cosmetic Doctor would have handled Senior P.A.s erythrodermic psoriasis patient...