Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA.
Interact Cardiovasc Thorac Surg. 2022 May 2;34(5):791-798. doi: 10.1093/icvts/ivab371.
Our study examined attitudes towards initial management of hyperhidrosis, willingness to seek surgical consultation and knowledge of an appropriate specialty for surgical consultation among primary care physicians and the general public.
An online survey was sent to all general medicine and paediatric residents and attending physicians at our academic medical centre. Participants were provided with a clinical scenario of palmar hyperhidrosis and were asked to select among initial management options and preferences for surgical consultation if patients failed non-operative management. To assess the general public's perspective, workers from Amazon Mechanical Turk were recruited to complete a similar survey.
The majority of primary care physicians (31/53; 58%) would prescribe topical aluminium chloride for palmar hyperhidrosis, whereas 28 of 53 (53%) would refer such patients to dermatology. Twenty-three of 53 (43%) physicians would refer such patients to surgery if conservative management failed: 18 (78%) to plastic surgery, 4 (17%) to general surgery and none to thoracic surgery. The majority of workers (130/205; 63.4%) would seek primary care treatment for palmar hyperhidrosis. Over half (113/205; 55%) would seek surgical consultation if conservative management failed: 65 (58%) general surgery and 15 (13%) neurosurgery, with only 8 (7%) selecting thoracic surgery.
Neither primary care physicians nor the general public recognize the role of thoracic surgeons in managing primary focal hyperhidrosis when medical management fails. Education of physicians and the public may mitigate this knowledge gap.
我们的研究调查了初级保健医生和普通公众对多汗症初始治疗的态度、对手术咨询的意愿以及对手术咨询合适专业的了解。
我们向我们的学术医疗中心的所有普通内科医生和儿科住院医生和主治医生发送了在线调查。参与者收到了手掌多汗症的临床病例，并被要求在非手术治疗失败的情况下选择初始治疗方案和手术咨询的偏好。为了评估普通公众的观点，我们招募了亚马逊土耳其机器人的工作人员来完成类似的调查。
大多数初级保健医生（31/53；58%）会开处方治疗手掌多汗症的氯化铝，而 53 名中的 28 名（53%）会将此类患者转介至皮肤科。如果保守治疗失败，23 名医生（43%）会将此类患者转介至手术：18 名（78%）转至整形外科，4 名（17%）转至普通外科，无一人转至胸外科。大多数工人（130/205；63.4%）会因手掌多汗症寻求初级保健治疗。如果保守治疗失败，超过一半（113/205；55%）会寻求手术咨询：65 名（58%）普外科，15 名（13%）神经外科，只有 8 名（7%）选择胸外科。
当药物治疗失败时，初级保健医生和普通公众都没有认识到胸外科医生在治疗原发性局灶性多汗症中的作用。对医生和公众进行教育可能会缩小这一知识差距。
