Caring for Patients: Lessons From My Podiatrist Parents and Other Amazing Mentors

Sweeping up toenails—this was my first memory of “working” in medicine. Whenever there was a day off from school, my 3 siblings and I would go to my parents’ office, and we were put to work. We filed paper charts alphabetically, made postprocedure bandaging care packages, organized the magazines in the waiting room, greeted patients as they came in, and swept up the toenail clippings on the floor. It was far from glamorous. But it was important work, and we were proud to do it. It must have made an indelible impact, as 3 of us went into medicine (2 became dermatology physician assistants (PAs) and the other a podiatric surgeon; my brother is a lawyer, but at least he married a great derm PA).

Reflecting on my 22+ years in dermatology, the most important lessons I have learned about caring for patients came from those humble beginnings and closely observing my fantastic colleagues along the way. In addition to the countless clinical lessons, I have learned to be happy, stay humble, and be brilliant.

Be Happy

Anyone who has ever met my mother usually asks me, “Is she always that happy?” And my answer is always “yes.”

My mother is a podiatrist, as was her mother before her. Growing up, my mother always had the old leather doctor’s bag in the back of her conversion van. On the way home from school, we often had to stop and make a house call, or she had to check in on a patient. She was one of the only podiatrists who took Medicaid; she also visited nursing homes in my hometown. Her patients often could not come into the office to see her, so she went to them.

Many times after she picked me up from school, I would carry her doctor’s bag into a nursing home to see a bedridden patient. Although I was a bit afraid of the machines, noises, and smells coming out of these dark and sad nursing homes, my mother always made the best of every situation. She would walk in singing or humming, open their curtains, wish them a big, happy “good morning” (no matter the time of day), and then care for them. I would help her remove their socks or stockings and bandages, and she would be smiling, singing, and making each patient feel like they were the most important person in the world. And, for just a moment, they were.

In the middle of a busy shift or during the grind of a very hectic day, we can easily forget that patients sometimes come to us in their most vulnerable state or on their worst day. Sometimes they are not kind to our front staff. Sometimes, they are grouchy with our nurses. But their defensive walls often come down if we strive to smile and make them feel comfortable and cared for. Perhaps more importantly, studies have shown that patients who are connected with their clinicians feel listened to and are part of the decision-making process. They have better adherence to treatment regimens, leading to better outcomes.

So, during our busy day, dermatology providers should strive to go the extra mile to make a connection, find something we have in common with our patients, and take the time to listen to their journey—with a smile. As one of my mentors astutely said, “The worst day in dermatology is far better than the best day in most other fields of medicine.” Be proud that you are a dermatology provider and happy that patients trust you with their skin health.

Be Humble

My father is 6 ft 7 in tall. One of the first lessons he taught me about patient care was that height, like intelligence, can be extremely intimidating. The first thing he did as he entered a patient’s room was sit on a stool positioned so the patient’s chair was higher than his.

He said this accomplished a couple of things: It immediately removed the intimidation of the height and put the patient in a position of power, albeit just the illusion of having the higher ground. Patients were less defensive. When they felt like they had a position of authority, they would share more. Ultimately, he wanted to let the patient know that he was their humble servant, there to care for them.

My father is hardworking, incredibly kind, and ridiculously intelligent. He came from humble Irish beginnings and greatly valued higher education. He had a love of learning that continued throughout his 50+ year career as a podiatric surgeon. He loved lecturing at podiatry conferences and teaching his patients about caring not just for their feet but also how to better care for their overall health. He loved educating patients about their conditions. He would see patients for their plantar warts and end up discussing how they can boost their overall immunity to prevent all viruses, not just human papillomavirus. He used plain language, but he also used medical terminology. It was a tactic that allowed him to remain a humble educator.

This humility is echoed in so many amazing dermatology providers. I see glimpses of it constantly from the great dermatology experts on the podium and the collaborative physicians with whom I have been blessed to work.

Being humble can also keep you out of trouble. My longest-running collaborative physician always said, “There will be a lot of patients that love you, but beware—they will not always be big fans.” Most patients will be grateful for our time, attention, and diligent care. However, in our very litigious society, we always need to be aware of those who may show warning signs of being unhappy with our work. If you remain humble and always do what is best for each patient, you can hopefully avoid nasty legal battles.

Be Brilliant

I think every provider, having gone through the rigors of medical school, PA school, or the doctor of nursing practice curriculum, has had a moment of panic, probably during a pharmacology or pathophysiology class, when they thought, “How am I ever going to learn all of this?”

My first employer/supervising physician was a brilliant dermatologist who had practiced for over 25 years. He had never had a PA but often had residents rotate through his extremely busy dermatology clinic in Jacksonville, Florida. He knew it all. He could diagnose skin cancer from across the room (without dermatoscopes because they did not exist then). He knew how to treat every complex medical derm issue. He kept up with the latest and greatest therapies and constantly strived to improve patient outcomes.

He taught me the importance of learning from everyone, especially the nurses who had been doing this much longer than I and the pharmaceutical reps who brought us information on disease states and treatment options. He also taught me things about the art of medicine. I observed how he made his few precious minutes with each patient feel like triple the time.

Yet I still had so much to learn when my husband and I moved to Naples, Florida. I joined another stellar solo physician who had the “If you build it, they will come” business mentality. He was a wonderful Mohs surgeon and an even better businessperson—a rare combination. He saw the value and potential in hiring an inexperienced PA hungry to learn. He told me he wanted to cut out skin cancers, and he was going to train me to do almost everything else. He encouraged me to find my passion and what I really loved to treat. We spent countless hours during lunch breaks and after patient hours going through textbooks and reviewing journal articles.

I also observed and learned from his incredible bedside manner. He had a calm confidence that made patients know they were in good hands. He found a way to make a connection with each patient, whether it was asking about where they were from, their favorite sports team, or their hobbies and interests. He found common ground.

When he left clinical practice to continue running his bustling business as chief medical officer, I received the gift of my third and current collaborative physician. She is a triple board-certified pediatric dermatologist who joined our practice from Pittsburgh, Pennsylvania. She is phenomenal. I have learned so much from our discussions about patient care. She is so supportive of advanced practice providers. She has been a cheerleader for my endeavors and interests. Our combined lecturing efforts outside of patient care have been amazing.

Throughout my 22 years in dermatology, I have learned that we may never know it all, but we can continue to strive to learn more every day. We need to continually push ourselves to be knowledgeable about the latest options available to patients.

My humble advice to dermatology clinicians is always to strive to improve. Always push yourself to learn more and learn from your collaborative team. Go to conferences, listen to as many virtual lectures as you can, or start a journal club in your local area and learn from your colleagues. Do everything you can to be the most brilliant, happy, and humble dermatology provider your patients have seen. Your future patients are counting on you.

Shanna Miranti, MPAS, PA-C, is a board-certified physician assistant, a founding member of Riverchase Dermatology in Naples, Florida, and a Diversity in Dermatology board member.