[Comment on the cooperation between general practitioners and dermatologists in private practices]

Area of Science:

• Dermatology
• General Practice
• Oncology

Background:

• Referral patterns and diagnostic accuracy of general practitioners (GPs) and other specialists (OS) for new skin problems were evaluated.
• A significant proportion of patients visiting dermatologists were referred by GPs.
• The study highlights the importance of the interface between primary care and specialist dermatology.

Purpose of the Study:

• To assess the diagnostic accuracy of GPs and OS in identifying new skin conditions.
• To determine the proportion of skin malignancies among referred patients.
• To evaluate the impact of referral pathways on dermatological care quality.

Main Methods:

• Prospective data collection from patients referred to four dermatologists in northwestern Switzerland over an eight-month period in 2003.
• Analysis of referral sources (GPs vs. OS) and diagnostic accuracy rates.
• Specific evaluation of diagnostic accuracy for non-pigmented and pigmented skin tumors, including basal cell carcinoma (BCC) and malignant melanoma.

Main Results:

• 20.5% of patients with new skin problems were referred to dermatologists, predominantly by GPs (83.4%).
• GP diagnostic accuracy was 54.3% (family physician), 52.3% (internist), and 66% (pediatrician), comparable to OS (53.4%).
• Skin malignancy was found in 42.3% of referrals for non-pigmented skin tumors and 5.8% for pigmented skin tumors. GP accuracy for BCC was 42.9% and for malignant melanoma was 41.7%.

Conclusions:

• GPs possess moderate diagnostic accuracy for new skin conditions, necessitating specialist referral for accurate diagnosis and management.
• A significant number of skin malignancies are identified through referrals, underscoring the importance of the GP-dermatologist relationship.
• Restricting direct access to either GPs or dermatologists could compromise the quality of dermatological care.