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Primary care-based dermatology practice: internists need more training.

G M McCarthy1, G C Lamb, T J Russell

  • 1Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee.

Journal of General Internal Medicine
|January 1, 1991
PubMed
Summary
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Internal medicine physicians can diagnose many skin conditions with limited dermatology training. However, diagnostic errors and inappropriate management highlight the need for enhanced dermatology education for primary care physicians.

Area of Science:

  • Dermatology
  • Medical Education
  • Primary Care

Background:

  • Primary care physicians increasingly manage dermatologic disorders.
  • Formal dermatology training for internists is often limited.
  • Accurate diagnosis and management of skin conditions are crucial for patient outcomes.

Purpose of the Study:

  • To assess the diagnostic and management capabilities of internal medicine faculty in a primary care setting.
  • To evaluate the appropriateness of treatment and referral for dermatologic conditions by internists.
  • To identify gaps in dermatology knowledge and training among internists.

Main Methods:

  • Prospective study involving 20 patient case presentations (photographs and histories) of dermatologic disorders.
  • 17 faculty internists evaluated cases via questionnaire.

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  • Responses were compared against a reference standard of three board-certified dermatologists.

    • Main Results:

    • Internists diagnosed 60% of cases correctly; 89% of these were appropriately managed or referred.
    • In 40% of incorrect diagnoses, internists failed to refer, leading to inappropriate treatment.
    • Only 62% of appropriate referrals were made, while 33% of referrals were deemed unnecessary.

    Conclusions:

    • Faculty internists demonstrated some ability to diagnose common skin diseases despite minimal formal dermatology training.
    • Diagnostic errors were frequent, often resulting in inappropriate management and referrals.
    • Current dermatology training appears insufficient for primary care physicians' evolving role in skin disorder management.