How well do family physicians manage skin lesions?

Practice BLOCKINrecommendation z Family physicians can feel comfortable that most patients whom they treat with skin disorders improve (B). T he bite of a brown recluse spider is dangerous, leading to necrosis and possibly death, right? That supposition is widely held and backed by studies. In fact, conventional wisdom says if a person is bitten by a brown recluse spider, serious complications are the norm and the best course of action is aggressive treatment in a hospital. The studies supporting this view, however, were conducted in tertiary care settings, which do not always represent primary care settings. 5 examined the characteristics of brown recluse spider bites in outpatient settings, they found that 43% of patients healed within 2 weeks and only 1 in 149 patients required hospitalization. Is it likely other skin disorders seen in primary care also have clinical courses more favorable than when seen in tertiary care centers? This was one of our hypotheses, and we structured our study to determine the percentage of the skin lesions that improved after evaluation and management by family physicians. z How BLOCKINdo BLOCKINFPs BLOCKINcompare with BLOCKINdermatologists? Dermatology literature boasts about the superiority of the dermatologist in diagnostic ability, cost savings, and cancer prevention when compared with primary care physicians. 6–10 Studies have evaluated the skill level of primary care physicians compared with dermatologists in identifying skin disorders when tested with color transparencies, computer images, and slides—however, rarely with actual patients. Some studies have suggested a higher rate of referral for skin problems than for other non-derma-tologic conditions. Often the outcome of interest in these studies is disease-oriented, judging a physician's diagnostic ability, rather than examining a patient-oriented outcome, such as resolution of lesion or patient satisfaction. Thus, the secondary aims of our study were to observe how family physicians diagnose and treat the lesions, and to gauge their concordance with dermatologists' assessments and plans. We hypothesized that, in an office setting, family physicians would provide effective and efficient treatment for most patients who present with new skin lesions, and that there is high diagnostic concordance between the 2 specialties. We first share our study findings, and How BLOCKINwell BLOCKINdo BLOCKINfamily BLOCKINphysicians manage BLOCKINskin BLOCKINlesions? results of this prospective cohort study put them on a par with their dermatologist colleagues