Comparison of dermatologic diagnoses by primary care practitioners and dermatologists. A review of the literature

Abstract

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.