BACKGROUND: Managed care in the American health care system may limit access to health care specialists. OBJECTIVE: We assessed primary care providers' abilities at diagnosing and treating patients with a previously undiagnosed skin disorder. METHODS: Patients with previously undiagnosed skin disorders were seen and examined sequentially by three groups of physicians: (1) internal medicine residents, (2) board-certified internal medicine attending physicians and (3) dermatology faculty. The internal medicine residents and attending physicians' diagnoses were compared with the dermatologists'. Appropriateness of therapy ordered by the internal medicine residents and attending physicians was assessed. RESULTS: Medical residents' diagnoses were correct in 43% of the patients whereas the attending physicians diagnosed 52% of cases correctly. Attending physicians and residents frequently ordered therapy inappropriate for the patient's diagnosis. Internal medicine residents and attending physicians were more likely to order skin biopsies than dermatologists. CONCLUSIONS: Our results confirm earlier studies that nondermatologists perform poorly in the diagnosis and treatment of skin disease. Primary care providers should receive more training in dermatology, or dermatologists should be permitted to act as primary caregivers to patients with skin disease.
BACKGROUND: Managed care in the American health care system may limit access to health care specialists. OBJECTIVE: We assessed primary care providers' abilities at diagnosing and treating patients with a previously undiagnosed skin disorder. METHODS:Patients with previously undiagnosed skin disorders were seen and examined sequentially by three groups of physicians: (1) internal medicine residents, (2) board-certified internal medicine attending physicians and (3) dermatology faculty. The internal medicine residents and attending physicians' diagnoses were compared with the dermatologists'. Appropriateness of therapy ordered by the internal medicine residents and attending physicians was assessed. RESULTS: Medical residents' diagnoses were correct in 43% of the patients whereas the attending physicians diagnosed 52% of cases correctly. Attending physicians and residents frequently ordered therapy inappropriate for the patient's diagnosis. Internal medicine residents and attending physicians were more likely to order skin biopsies than dermatologists. CONCLUSIONS: Our results confirm earlier studies that nondermatologists perform poorly in the diagnosis and treatment of skin disease. Primary care providers should receive more training in dermatology, or dermatologists should be permitted to act as primary caregivers to patients with skin disease.
Authors: Suephy C Chen; Michelle L Pennie; Paul Kolm; Erin M Warshaw; Eric L Weisberg; Katherine M Brown; Michael E Ming; William S Weintraub Journal: J Gen Intern Med Date: 2006-07 Impact factor: 5.128
Authors: Jacqueline Dinnes; Jonathan J Deeks; Naomi Chuchu; Rubeta N Matin; Kai Yuen Wong; Roger Benjamin Aldridge; Alana Durack; Abha Gulati; Sue Ann Chan; Louise Johnston; Susan E Bayliss; Jo Leonardi-Bee; Yemisi Takwoingi; Clare Davenport; Colette O'Sullivan; Hamid Tehrani; Hywel C Williams Journal: Cochrane Database Syst Rev Date: 2018-12-04
Authors: Jacqueline Dinnes; Jonathan J Deeks; Matthew J Grainge; Naomi Chuchu; Lavinia Ferrante di Ruffano; Rubeta N Matin; David R Thomson; Kai Yuen Wong; Roger Benjamin Aldridge; Rachel Abbott; Monica Fawzy; Susan E Bayliss; Yemisi Takwoingi; Clare Davenport; Kathie Godfrey; Fiona M Walter; Hywel C Williams Journal: Cochrane Database Syst Rev Date: 2018-12-04
Authors: Nicholas J Goetsch; James D Hoehns; John E Sutherland; Matthew E Ulven; Olayinka O Shiyanbola; Monica K Rauch Journal: SAGE Open Med Date: 2017-03-15
Authors: Adam R Ford; Caitlin M Gibbons; Josefina Torres; Heather A Kornmehl; Sanminder Singh; Paulina M Young; Cindy J Chambers; Emanual Maverakis; Cory A Dunnick; April W Armstrong Journal: Telemed J E Health Date: 2018-09-14 Impact factor: 3.536