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Family physicians manage skin conditions well

Patients visit family physicians for skin conditions that range from athlete's foot, to eczema, to precancerous lesions. Most skin conditions managed by family physicians improve and most patients are satisfied with the care they receive for their skin lesions, according to a new study. A total of 85 percent of patients contacted a week after their visit to the family physician for a skin lesion said their lesions were "better" or "much better." Moreover, patients said they were highly satisfied with their care. Referrals to subspecialists such as dermatologists were rare. Also, the diagnosis and treatment of skin lesions by family physicians correlated well (72 and 80 percent, respectively) with that of two dermatologists who independently reviewed patient histories and digital photos of the lesions.

These findings counter those of previous studies questioning primary care physicians' care of dermatologic conditions. David Meyers, M.D., of the Agency for Healthcare Research and Quality, notes that earlier work, which often relied solely on diagnosis from photographs and other nonclinical methodologies, may have underestimated the importance of the clinical encounter. He points out that this practice-based study reports on patient-centered outcomes of the care provided by practicing clinicians for their own patients.

Dr. Myers and colleagues examined the diagnosis, treatment, and outcomes of 244 patients (aged 3 months to 86 years) with new skin lesions who were seen by 53 family physicians at several study sites in 3 States. The doctors completed surveys about diagnosis and treatment after seeing each patient. Patients were interviewed on days 7, 28, and 84.

To make their diagnosis, most family physicians examined other parts of the skin (70 percent), consulted a colleague (14 percent), or consulted an electronic resource (6 percent). Laboratory tests, skin scrapings, diagnostic cultures, Woods lamp exams, or skin biopsies were performed in a total of 10 percent of visits.

See "How well do family physicians manage skin lesions?" by Dan Merenstein, M.D., Dr. Meyers, Alex Krist, M.D., and others, in the January 2007 Journal of Family Practice 56(1), pp. 40-45.

Reprints (AHRQ Publication No. 07-R052) are available from the AHRQ Publications Clearinghouse.

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