A Playful Way to Compare Notes
In this lighter installment of SkinSync, PA Shanna Miranti and PA Buchi Neita trade a round of dermatology "would you rather?" questions drawn straight from the everyday frustrations that show up on APP schedules. Miranti frames the game as a way for the two hosts—and the audience—to learn each other’s preferences and recognize that dermatology PAs and NPs everywhere wrestle with the same room-to-room dilemmas.
The exercise is deliberately practical, not academic. Each scenario is one Neita and Miranti say they actually encounter in clinic, and their answers double as small windows into how experienced clinicians triage personality, workflow, and time pressure across a busy day.
Kids, Grouchy Grandpas, and Winning Over the Room
The first matchup—a screaming child versus a grouchy older patient—splits the hosts. Neita takes the grouchy older man "a thousand percent of the time," noting that with a little conversation about grandkids, a spouse, or an upcoming cruise, those patients are easy to win over. Miranti, mother of four, leans into the pediatric room instead, happy to get on the floor, blow up a glove balloon, and make faces.
Miranti's most portable tip: a treasure box. She describes an inexpensive pirate-style treasure box kit purchased on Amazon, stocked with small plastic toys and stickers, that she uses to reward pediatric patients. She prefers junky little toys over candy so she isn't "piping them up on sugar" before sending them home—an idea Neita immediately said she wanted to adopt.
The Hard Parent Conversations
Asked to choose between an acne teen whose mother refuses isotretinoin and a child with atopic dermatitis whose mother wants only "natural and clean" ingredients, both hosts pick the acne case. Neita says she is passionate about treating acne and about isotretinoin, and that she leads with questions—asking parents why they feel the way they do rather than pushing. That approach, she says, feels less intrusive and lets her uncover and correct misinformation, whether it came from social media or a "friend's neighbor's ex-dog walker."
Miranti agrees, adding that the teenager is rarely the obstacle—the patient is the one living with and hating the breakouts. Digging deeper with resistant parents and replacing rumor with accurate risk-and-benefit information, she says, can genuinely change a child’s life. Both recommend having a ready "script" to pull out when parents put up a strong wall.
Lists, Full-Body Exams, and Fellow Clinicians
On the full-body skin exam question, Neita prefers the patient who's gowned and ready for ten biopsies and a barrage of cryotherapy over the patient with a 47-item list, because she values clarity and a focused workflow. Miranti loves working tip-to-toe in her own systematic order and finds a jumping-around checklist harder—but she offers a strategy for the list patient: if a concern like hair loss needs a detailed conversation, tell them so and schedule a dedicated return visit rather than getting stuck in the room for half an hour.
When it comes to seeing fellow medical professionals versus a trusting patient who wants the clinician to decide everything, both now choose the medical provider, citing how much they enjoy detailed therapeutic conversations—Miranti mentions new psoriasis patients specifically. Both note, though, that earlier in their careers they'd have picked the trusting patient, and Neita encourages new APPs not to be intimidated: know your stuff, be confident, and lean into those deeper discussions.
Why Warts Are Winning
The running joke of the episode is that warts keep winning. Faced with five plantar warts versus five patients with thinning hair, both hosts take the warts. Miranti credits a compounded topical of fluorouracil with salicylic acid—a method she attributes to Dr. Lisa Swanson—as a beautifully effective, if out-of-pocket and somewhat pricey, alternative to cryotherapy alone. Hair loss, by contrast, is almost never a short visit, requiring workup, counseling, and hand-holding that a single slot can't always accommodate.
On seborrheic keratoses versus a painful pilonidal abscess, the hosts diverge—Neita takes the SKs every time, and highlights compounded SK pens patients can apply at home (used diligently for two to three weeks) after she freezes the most bothersome lesions. Miranti, who does fewer surgical procedures, actually enjoys draining a cyst as her version of surgery: goggles on, music playing, quick relief for the patient. Finally, on genital warts versus a genital herpes diagnosis, both again choose warts. Neita notes HSV patients are often misdiagnosed as recurrent shingles and that pinning down timing of exposure—and defusing accusations between partners—makes it a far harder conversation, even though valacyclovir makes the treatment itself straightforward. Miranti stresses counseling male patients about HPV transmission and cervical risk, ideally with handouts available in multiple languages.