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Dermatology Education for Internists
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We read with interest the article by Feldman and colleagues,1 who report on the most common dermatologic problems identified by internists. We found the data on the number, percentage, and ethnicity of patients with dermatologic disorders seen by internists compared with those seen by dermatologists informative. Unfortunately, using various methods, internists have repeatedly incorrectly diagnosed skin disorders at a rate of 50%.2-5 Therefore, using a database that is based on self-coding by internists incorporates a possible 50% error into dermatologic diagnoses. While educational efforts for internists in dermatology are worthwhile, the foundation of any educational program for internists should not be based on data with this degree of potential error.
Robert S. Kirsner, MD
Miami, Fla
Daniel G. Federman, MD
New Haven, Conn
1. Feldman SR, Fleischer AB Jr, McConnell C. Most common dermatologic problems identified by internists, 1990-1994. Arch Intern Med. 1998;158:726-730.
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2. Ramsey DL, Fox AB. The ability of primary care physicians to recognize the common dermatoses. Arch Dermatol. 1981;117:620-622.
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3. Federman D, Hogan D, Taylor JR, Caralis P, Kirsner RS. A comparison of diagnosis, evaluation, and treatment of patients with dermatologic disorders. J Am Acad Dermatol. 1995;32:726-729.
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4. Kirsner RS, Federman DG. Lack of correlation of internists' abilities in dermatology and their patterns of treating patients with skin disease. Arch Dermatol. 1996;132:1043-1046.
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5. McCarthy GM, Lamb GC, Russell TJ, Young MJ. Primary care based dermatology practice: internists need more training. J Gen Intern Med. 1991;6:52-56.
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Arch Intern Med. 1998;158:1952-1953.
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