Primary care-based dermatology practice: internists need more training. J Gen Intern Med 1991;6(1):52-6
Date
01/01/1991Pubmed ID
1999747DOI
10.1007/BF02599393Scopus ID
2-s2.0-0025975398 (requires institutional sign-in at Scopus site) 51 CitationsAbstract
OBJECTIVE: To evaluate the ability of teachers in an internal medicine clinic to appropriately diagnose, treat, and refer for specific dermatologic disorders.
DESIGN: Prospective study.
SETTING: Medical school-affiliated primary care clinic.
PATIENTS/PARTICIPANTS: Case presentations of 20 patients who had dermatologic problems were prepared in the form of photographs with accompanying histories. All cases were presented to 17 of 21 available faculty internists who answered questions concerning diagnosis and management of the cases on a questionnaire. The responses of three board-certified faculty dermatologists were used as a reference standard.
MEASUREMENTS AND MAIN RESULTS: The internists had had an average of three weeks' total formal dermatology training. Overall, 60% of cases were correctly diagnosed by the internists and 89% of these were either treated appropriately or referred to dermatologists. In 40% of incorrectly diagnosed cases, internists failed to refer and the majority of these were treated inappropriately. Of referrals deemed appropriate by dermatologists, only 62% were made. Conversely, 33% of referrals were deemed unnecessary.
CONCLUSIONS: Faculty internists were able to diagnose many common skin diseases despite having received little dermatology training. However, errors in diagnosis occurred frequently and when diagnoses were incorrect there was a tendency to mismanage. These data suggest that the current amount of dermatology training is inadequate to prepare future primary care physicians for their increased role in the management of skin disorders.
Author List
McCarthy GM, Lamb GC, Russell TJ, Young MJAuthor
Geoffrey Lamb MD Emeritus Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultDermatology
Diagnostic Errors
Faculty, Medical
Humans
Internal Medicine
Outpatient Clinics, Hospital
Physicians, Family
Primary Health Care
Prospective Studies
Referral and Consultation
