Small vessels (and big opportunities for collaboration and learning)

This morning in Dermatology clinic I witnessed a great breadth of presentations, from basal cell carcinomas quickly remedied by in-office removal, to following the regression of silvery scales of psoriasis after optimization of a patient's treatment plan. I also saw two cases of suspected vasculitis, one of which turned out to be IgA nephropathy, now requiring careful thought and continuation of management post-discharge.

To me, the vasculitides have come to epitomize those diagnoses in medicine that bring together teams of clinicians and care providers, all trying to offer their expertise in fitting together the pieces of a diagnostic puzzle, and offer insights into best practices in management and patient care. And it is in these experiences in collaborative care, that I've found opportunities for truly rich learning.

Today for instance, I sat with the senior Dermatology resident, poring over the patient's chart and work-up. We reviewed investigations initiated by the in-hospital GIM service, which were complemented by a tissue sample procured by the on-call Dermatology team, and analyzed by Pathology. In interpreting the patient's testing we reminded ourselves of the nuances of Hepatitis B serologies, discussed the merits of inflammatory markers like ESR and CRP, and learned from one of the Family Medicine residents about updates to preferred antibiotic coverage for the patient's foot wounds. We also discussed next steps, including referrals to Rheumatology and Wound Care.

This clinic experience not only gave me a (much needed) chance to substantiate my approach to vasculitides, but lent me insight into the complementary roles and insights we provide as members of distinct, but inter-related care teams. I think back to my experiences as a CC3 in a Rheumatology clinic, my weeks on General Internal Medicine, bedside teaching from a Podiatrist, and today, in the Dermatology clinic, and the skills and insights gained from looking at the same clinical entities in slightly different ways. I'm excited to take these opportunities over the next month (and as I move into residency) to better understand the pearls and priorities from various teams, to inform my own practice as a clinician.

-AS