Fleischer A B, Feldman S R, McConnell R C
Department of Dermatology, Bowman Gray School of Medicine, Winston-Salem, NC, USA.
Fam Med. 1997 Oct;29(9):648-52.
Because all family physicians see numerous patients with dermatologic complaints, their education in skin disorders is important. Data are needed to help program directors know which areas of dermatology deserve the most time and emphasis. This study determined what types of skin problems family physicians most commonly diagnose.
Study researchers analyzed National Ambulatory Medical Care Survey data from 1990 to 1994 for dermatologic diagnoses. We then compared physicians specializing in family practice and its related fields (general practice, family practice sports medicine, and family practice geriatrics) with dermatologists and other physicians.
The most common skin disorders diagnosed by family physicians were dermatitis (16.4% of all diagnoses), pyoderma (13.7%), wart (8%), tinea infection (5.4%), and epidermoid cyst (5.1%). The top 10 most common diagnoses accounted for 65% of all skin-related diagnoses, and the top 20 most common diagnoses accounted for 81.8%. Family physicians more commonly saw patients for infectious processes, infestations, and insect bites, while dermatologists were more likely to see patients for psoriasis, alopecia, and rosacea.
Skin disorders diagnosed by family physicians differ considerably from those diagnosed by dermatologists. Because dermatologists do much of the dermatology teaching of family practice residents, it is important to recognize these dissimilarities to place emphasis on the proper areas of study. Some common or serious conditions, such as psoriasis and melanoma, are not often diagnosed by family physicians and also deserve attention in family practice training programs.
由于所有家庭医生都会诊治大量有皮肤病主诉的患者,因此他们接受皮肤病方面的教育很重要。需要数据来帮助项目主任了解皮肤病学的哪些领域最值得投入时间和重点关注。本研究确定了家庭医生最常诊断的皮肤问题类型。
研究人员分析了1990年至1994年国家门诊医疗护理调查中有关皮肤病诊断的数据。然后,我们将从事家庭医学及其相关领域(普通医学、家庭医学运动医学和家庭医学老年医学)的医生与皮肤科医生及其他医生进行了比较。
家庭医生最常诊断的皮肤疾病是皮炎(占所有诊断的16.4%)、脓皮病(13.7%)、疣(8%)、癣感染(5.4%)和表皮样囊肿(5.1%)。最常见的前10种诊断占所有皮肤相关诊断的65%,最常见的前20种诊断占81.8%。家庭医生诊治感染性疾病、寄生虫感染和昆虫叮咬患者更为常见,而皮肤科医生诊治银屑病、脱发和酒渣鼻患者的可能性更大。
家庭医生诊断的皮肤疾病与皮肤科医生诊断的有很大差异。由于皮肤科医生承担了家庭医学住院医师皮肤病学教学的大部分工作,认识到这些差异对于在适当的研究领域重点关注很重要。一些常见或严重的疾病,如银屑病和黑色素瘤,家庭医生并不经常诊断,在家庭医学培训项目中也值得关注。