Journal of Dermatology for Physician Assistants

The official journal of the Society of Dermatology Physician Assistants

Hold the Cannonfire, Eat the Peanuts: What the Thymus Tells Us About Diplomacy and Fellowship

By Peter A. Young, MPAS

The history of American medicine is filled with controversies and heated disagreements. My favorite example occurred in 1856, when the faculty and students of an Ohio medical college split into two factions over the school’s financial management. One group locked its opponents out of the building, who then amassed at the doors with pistols and bludgeons. The disagreement was settled with the arrival of a field cannon similar to those used in the Civil War.1

Thankfully today’s healthcare ecosystem is free of similar standoffs, but of course we have professional disputes. Some physician organizations oppose the PA title change, and journals occasionally publish work resembling pre-conceived assertions of PA ineptitude. History will tell if such articles will be perceived as valid objective research. Until then, I find the term Diplomate Fellow a helpful guide for my career activities, by contemplating its word roots.

Diplomate shares etymology with diplomat: someone who can effectively and sensitively deal with people. Fellows can refer to individuals engaged in a shared activity or interest. All medical professionals are each other’s fellows to a degree, by merit of sharing the same overarching goal: safe and responsible provision of quality patient care. Perhaps if we embody the term Diplomate Fellow by contributing skilled work while respecting the entire healthcare team, prejudice about PAs will quietly be forgotten.

Clinicians in the future may puzzle over the banality of today’s feuds and once-controversial ideas: PAs and physicians rely on each other, we aren’t interchangeable, and both ultimately serve the patient. As with all of nature, modern society is comprised of interdependent life forms in constant evolution. This mentality of more team-oriented relations might be made more mutually comfortable and widely adopted by promoting early career academic collaboration between PAs and doctors.

Nothing has grown my empathy and respect for physicians more, and perhaps vice versa, than joining their pursuit of discovering and sharing new knowledge (i.e., dermatologic research). In this way, my experiences co-authoring with medical students, residents, and dermatologists has reminded me of the recent discovery that peanut hypersensitivity is prevented by intentional exposure much earlier than previously taught dogma (during infancy).2

Like the thymus facilitates immune self-tolerance, scholarly activities can provide an opportunity to begin recognizing the self in each other, both as parts of the same whole. Nothing seems more diplomatic to me than pursuing objective truth in partnership with our fellow professionals, particularly those so expert in the tradition.

References
1. Felter HW. History of the Eclectic Medical Institute. Cincinnati: Published for the Alumni Association, 1902. Pages 39-42
2. Mikhail IJ. Implementation of Early Peanut Introduction Guidelines: It Takes a Village. Immunol Allergy Clin North Am. 2019;39(4):459-467. doi:10.1016/j. iac.2019.07.002

Acknowledgement: Current PA relationships with dermatologists and patients wouldn’t be possible without the decades of sacrifice given by dedicated leaders and volunteers of the Society of Dermatology Physician Assistants (SDPA). These individuals give up evenings and weekends for years to build and maintain an organization that has paved the path now walked by young PAs. Those of us early in our careers should thank our society’s veterans and pathbreakers by paying forward their altruism. If you can, volunteer your time and talents to help SDPA advocate for and educate your peers.

Peter A. Young, MPAS, is a visiting scholar at Stanford University School of Medicine in Redwood City, California, and a physician assistant at Kaiser Permanente in Sacramento, California.

Disclosures: The author has disclosed no potential conflicts of interest, financial or otherwise, relating to the content of this article.

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