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The Patient's Perspective

Daniel G. Federman, MD; M. Carrington Reid, MD, PhD; Steven R. Feldman, MD, PhD; Joshua Greenhoe, MD; Robert S. Kirsner, MD

Arch Dermatol. 2001;137:25-29.

Objective  To ascertain the patient's perspective on dermatologic care provided by primary care providers (PCPs) or dermatologists.

Design  Cross-sectional survey of patients drawn from primary care and dermatology clinics.

Setting  Academic Veterans Affairs medical center.

Patients  Convenience sample of patients in either a primary care or a dermatology clinic.

Intervention  Survey questionnaire.

Main Outcome Measures  Patients' confidence in having their skin problems cared for by PCPs and dermatologists and satisfaction with previous care rendered.

Results  A total of 137 patients in the primary care clinic (group 1) and 100 patients in the dermatology clinic (group 2) participated. Patients (N = 237) expressed confidence in their PCP's ability to treat rashes (62%), diagnose skin cancer (65%), perform skin biopsies (60%), "freeze" lesions with liquid nitrogen (50%), and perform cutaneous surgery (46%). Group 2 patients were significantly less likely to have confidence in their PCP than group 1 patients for all measures other than the use of liquid nitrogen. High levels of confidence were expressed in a dermatologist's ability for all 5 measures: 92%, 91%, 92%, 83%, and 85%, respectively. Patients were more confident in dermatologists' abilities to perform these procedures compared with PCPs (P<.001 for all comparisons). Of patients previously treated for skin disorders, there was a high rate of satisfaction with the treatment rendered by PCPs (81% for group 1 and 75% for group 2) and by dermatologists (92% for group 1 and 90% for group 2). However, patient satisfaction was higher for dermatology vs primary care for the treatment of skin disease (P<.001). Direct access to dermatologists was preferred.

Conclusions  Although patients have confidence in their PCP to care for their skin disease, they have greater confidence in the care provided by dermatologists. Among patients previously treated for skin disease, satisfaction was higher with care rendered by dermatologists vs PCPs. Most patients prefer direct access to dermatologists should they develop a skin problem.

From the Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn, and the Veterans Affairs Connecticut Health Care System, West Haven (Drs Federman, Reid, and Greenhoe); the Department of Dermatology, Westwood-Squibb Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Feldman); and the Departments of Dermatology and Cutaneous Surgery and Epidemiology and Public Health, University of Miami School of Medicine, Miami, Fla (Dr Kirsner).

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