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

Background: Cost-containment efforts in the United States have led to a gre ater 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 diagnos e 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-quali ty transparencies. Design: We performed a critical review of published studies. Results: Overall, dermatologists (93% correct) performed better than nonder matologists (52% correct) (P<.001). No difference was appreciable between d ermatology residents (91% correct) and practicing dermatologists (96% corre ct) or between internal medicine residents (45% correct) and family practic e residents (48% correct). In addition, family medicine attending physician s (70% correct) performed better than internal medicine attending physician s (52% correct) (P<.001). Conclusion: Primary care physicians should receive more training in the dia gnosis of skin disease.