THE CMG VOICE

What Physician Assistants should do when removing skin lesions

The Washington Medical Commission (WMC) is responsible for protecting the public by making sure that physicians and physician assistants (PAs) are providing quality health care in Washington State.

Their aims are similar to but slightly different from those of my office and my clients. Whereas I am concerned with helping just one client, the WMC is responsible for looking after the safety of all Washingtonians. This difference matters in the context of the harm caused by the substandard care.

For me, I must prove that the care provided by a doctor or PA caused harm to my client. The WMC, on the other hand, is more concerned with the behavior itself, whether or not it caused harm in a particular circumstance, but the potential for uncorrected behavior to cause harm to Washingtonians in the future.

My aim is to recover compensation for my client for the harm caused. The WMC is more focused on corrective action against the provider him or herself.

Those differences aside, the WMC and my clients are concerned about improving the safety of health care in Washington. To that aim, the WMC puts out a newsletter which includes in it some helpful advice for providers who read it.

Recently, a PA wrote about care surrounding removing suspicious skin lesions, and what to do with the specimen. For the safety of the patient, it’s important to either send any specimen to pathology so it may be examined microscopically for any worrisome characteristics, or if not, to document the characteristics of the specimen.

This can include describing the site, the size, and a description of the lesion. Taking a photograph for the file is also good practice.

In addition, the article recommends discussing with the patient if you are not planning on sending it to pathology, and what the possible ramifications of that are. I would not be surprised if such discussions are not commonplace, but they need to be if a patient is truly informed of his or her choices in the medical care received.

Finally, a follow up plan is important to have with the patient, in the event the lesion comes back.

These are good tips for all PAs in Washington to follow to improve the safety of all of us.

You can read the full article here:

[PA News: Protect Your Skin and Practice](https://wmc.wa.gov/sites/default/files/public/Newsletter/4.PANews.pdf)