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Comparison of Dermatologic Diagnoses by Primary Care Practitioners and Dermatologists
A Review of the Literature
Daniel G. Federman, MD;
John Concato, MD, MPH;
Robert S. Kirsner, MD
Arch Fam Med. 1999;8:170-172.
Background Cost-containment efforts in the United States have led to a greater emphasis on health care delivery by primary care physicians as opposed to specialists, who are assumed to be more costly. With this approach, it is incumbent on the primary care physician to be able to accurately diagnose and treat common maladies, including skin disease.
Objective To ascertain whether differences in performance were detectable between groups of physicians when presented with color slides or high-quality transparencies.
Design We performed a critical review of published studies.
Results Overall, dermatologists (93% correct) performed better than nondermatologists (52% correct) (P<.001). No difference was appreciable between dermatology residents (91% correct) and practicing dermatologists (96% correct) or between internal medicine residents (45% correct) and family practice residents (48% correct). In addition, family medicine attending physicians (70% correct) performed better than internal medicine attending physicians (52% correct) (P<.001).
Conclusion Primary care physicians should receive more training in the diagnosis of skin disease.
From the Department of Medicine, West Haven Veterans Affairs Medical Center, Yale University School of Medicine, West Haven, Conn (Drs Federman and Concato); and the Departments of Dermatology and Cutaneous Surgery and Epidemiology and Public Health, University of Miami School of Medicine, Miami, Fla (Dr Kirsner).
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