Daniel G. Federman, MD; Robert S. Kirsner, MD
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Federman D., Kirsner R.; Skin Biopsies, Cutaneous Disease, and Primary Care. Ann Intern Med. 1999;130:617. doi: 10.7326/0003-4819-130-7-199904060-00016
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Published: Ann Intern Med. 1999;130(7):617.
TO THE EDITOR:
Health care changes have dictated that primary care physicians deftly care for a broad spectrum of medical conditions. Implicit is the assumption that primary care practitioners can provide quality health care at a lower cost than specialists. Possibly succumbing to these forces, the American College of Physicians held several workshops in skin biopsy techniques during its 1998 Annual Session. Although knowledge of how to perform skin biopsies is needed, our enthusiasm is tempered by several concerns.
Several studies have demonstrated that nondermatologists are inferior to dermatologists in the diagnosis and treatment of skin disease (1-3). However, some studies have been small and have included medical students and physicians-in-training, thereby detracting from their conclusions. In addition, no study to date has demonstrated that patient outcomes differ whether patients are cared for by dermatologists or primary care physicians (4). If dermatologists are truly better at diagnosing and treating patients with skin disease, this is not a surprising finding. Dermatologists receive considerably more training in the care of patients with cutaneous disease and encounter more patients with skin disease in their daily practice.
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