After I took the job at Idaho Urgent Care, initially I worked on the Urgent Care side of the clinic where I treated everything from coughs, colds, sprains, broken bones, depression, anxiety, and I even performed many of the xray exams since I am a licensed Radiologic Technologist. But what I really loved was when a patient would come in with a rash or a suspicious mole, or acne. At that time Clearskin was staffed by a Physician Assistant by the name of Trent Shaw, who I still know today and is a wonderful PA. After several months, Trent moved on(he actually started working in Rexburg) which opened up the position at Clearskin. At first I felt a little overwhelmed by getting to treat all the things I liked to treat patient after patient. But as I studied and learned, I became more and more confident in my abilities and skills. It was during this period that I learned all the ins and outs of prescribing acne meds like Accutane(Isotretinoin), Oracea, Minocycline, Doxycycline, Bactrim, Amoxacillin, Keflex, and all the topicals that actually changed often as certain creams lost their patents and were replaced by more expensive new creams. I also learned more technical procedures like excising skin cancers like, Basal Cell Carcinomas, Squamous Cell Carcinomas, and Melanomas. I became very comfortable with these procedures although I knew my limits. If a melanoma was new, I would consult with the pathologist and make sure that it was within my scope of practice and ability to remove. If it was too deep, I would refer those to a plastic surgeon. Basal and Squamous Cell carcinomas can be fairly strait forward to excise, unless they are on the nose, close to the eyes, or on difficult parts of the ears. In those cases, I would refer those to one of the dermatologists for MOHS surgery. While working at Physician Skin Care I also learned how to inject Botox and fillers to help with wrinkles and creases that patients did not like. I was surprised how much money people will spend on those types of procedures. I was also involved in laser hair removal, chemical peels, and microderm abrasions. My experience with some of those procedures was not always positive. In fact, it seemed to me that most people that had laser hair removal were unhappy with the cost, the repeat treatments, and most importantly the result. There were people that liked the microderm abrasions and chemicals peels, but they usually had to come in for repeat treatments because the affects of the treatments would wear off or actually cause more acne and blemishes. But their skin was usually nice for the first several days after the treatment, so they would always come back to have the treatment again. I would have many of the procedures done on myself so that I could tell my patients what to expect, my skin would be great for 4-5 days, then I would break out. These are some of the reasons I did not want to do these types of cosmetic procedures in any clinic that I ran in the future. So in my next entry, I will write about what happened next. Brett Bagley PAC