Roland M O, Green C A, Roberts S O
University of Cambridge School of Clinical Medicine, Addenbrookes Hospital.
J R Soc Med. 1991 Jul;84(7):403-4. doi: 10.1177/014107689108400708.
Twenty-two patients with skin problems were identified on the basis that their general practitioner was satisfied with their management and had no intention of referring them to hospital. These patients were reviewed by one of two dermatologists who made treatment recommendations in 14 cases, and these suggestions were taken up by 11 patients. Six patients reported definite subjective improvement in their skin condition six weeks later. The general practitioners found the consultation valuable in 17 cases. Although these patients might have improved without the dermatologists' intervention, a group of patients may exist who would benefit from specialist advice, even though that advice has not been sought. Restriction on hospital referrals could therefore be detrimental to patient care. Controlled trials could be conducted to determine the benefit of specialist advice on patients not currently seen in hospital.
22名有皮肤问题的患者被确定，其依据是他们的全科医生对其治疗情况感到满意，且无意将他们转诊至医院。这22名患者由两名皮肤科医生中的一名进行复查，其中14例给出了治疗建议，11名患者采纳了这些建议。6周后，6名患者报告其皮肤状况有明显的主观改善。全科医生发现17例会诊很有价值。尽管这些患者即使没有皮肤科医生的干预可能也会有所改善，但可能存在一类患者，他们会从专科医生的建议中受益，即便尚未寻求此类建议。因此，限制医院转诊可能对患者护理不利。可以进行对照试验，以确定专科医生的建议对目前未在医院就诊的患者的益处。
