How well do family physicians manage skin lesions?

Dan Merenstein, David Meyers, Alex Krixst, Jose Delgado, Jessica L. McCann, Stephen Petterson and Robert L. Phillips

PURPOSE: Little is known about the epidemiology of new skin lesions seen in primary care. Our primary objective was to determine the percentage of the skin lesions that improved after evaluation by family physicians. Secondarily, we sought to determine patient satisfaction with their care, as well as diagnostic concordance between family physicians and dermatologists in diagnosing and treating skin lesions. METHODS: A prospective cohort study was done in two practice-based research networks. Patients with new skin lesions were eligible. Digital photographs, lesion descriptions and brief patient histories were collected in the family physician's office and independently reviewed by two dermatologists. Patients were administered a telephone survey at days 7, 28 and 84 after the visit to assess the status of lesions and their overall satisfaction with care. RESULTS: After 7 days, 84% of lesions were "much better" or "better." After 28 and 84 days, 89% and 94% of lesions respectively were rated similarly. Overall, patients were satisfied with the dermatologic care provided by their family physician, with 55% of patients reporting highest satisfaction level and 34% reporting second highest on a five point scale at day 7. At days 28 and 84, 93% of the patients reported the two highest levels of satisfaction. Overall diagnostic agreement was 72% between dermatologists and family physicians, with over 80% agreement for the more common diagnoses. CONCLUSION: Our study demonstrates that most skin lesions seen by office-based family physicians resolve within three months, patients are generally satisfied with the care they receive, and the diagnostic and treatment decisions made by primary care physicians are not significantly different from those of their dermatologic colleagues.

Merenstein D, Meyers D, Krist A, Delgado J, McCann J, Petterson P, Phillips RL. How well do family physicians manage skin lesions? J Fam Pract 2007; 56:40-45.