McGee R, Elwood M, Adam H, Sneyd M J, Williams S, Tilyard M
Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin.
N Z Med J. 1994 Jul 27;107(982):287-90.
To assess current levels of knowledge and management practices with respect to melanoma and other skin cancers, in a representative sample of New Zealand general practitioners.
A self-administered questionnaire was sent to a random sample of 900 general practitioners. The questionnaire included 12 cases with coloured photographs of skin lesions and a brief presenting history. Responders were asked to assess probable diagnosis, need for biopsy and management of the lesion. Other attitudinal and relevant background information was also gathered. The questionnaire was sent to a comparison sample of 35 dermatologists.
The overall response rate was 66% among the general practitioners and 68% among the dermatologists. The sample responding was representative of the larger population of doctors practising in New Zealand. Correct decisions whether or not to biopsy lesions (mean score of 10.1 out of 12) were significantly higher than the number of correct diagnoses (mean 8.4). Correct identification and recognition of the need to biopsy melanomas was high. Diagnostic skills and recognition of the need for biopsy were somewhat lower among general practitioners aged 50 years and over than among younger doctors. Doctors who had experience of a patient with melanoma had higher diagnostic skills and made more correct biopsy decisions. The general practitioners' scores for correct biopsy decisions were similar to those of the dermatologists sampled, although their diagnostic skills were somewhat lower, particularly with respect to nonmelanoma skin cancers.
The findings indicate a high level of expertise in terms of diagnosis of skin lesions and identification of need to biopsy suspicious lesions among general practitioners in this country.
在新西兰全科医生的代表性样本中，评估关于黑色素瘤和其他皮肤癌的当前知识水平及管理实践。
向900名全科医生的随机样本发送了一份自填式问卷。问卷包含12个带有皮肤病变彩色照片及简要病史的病例。要求受访者评估病变的可能诊断、活检需求及病变管理。还收集了其他态度和相关背景信息。问卷被发送给35名皮肤科医生的对比样本。
全科医生的总体回复率为66%，皮肤科医生为68%。回复样本代表了在新西兰执业的更大规模医生群体。判断是否对病变进行活检的正确决策（12分中平均得分为10.1分）显著高于正确诊断的数量（平均8.4分）。对黑色素瘤进行活检需求的正确识别率很高。50岁及以上的全科医生在诊断技能和对活检需求的认识方面略低于年轻医生。有黑色素瘤患者诊疗经验的医生诊断技能更高，做出的活检决策更正确。全科医生在正确活检决策方面的得分与抽样皮肤科医生相似，尽管他们的诊断技能略低，尤其是在非黑色素瘤皮肤癌方面。
研究结果表明，该国全科医生在皮肤病变诊断和识别可疑病变活检需求方面具有较高的专业水平。
