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In the April issue of the ARCHIVES, Sellheyer and Bergfeld¹ provided a variety of possible explanations for why the plastic surgeons in their pilot study performed so many more excisional biopsies for actinic keratoses than did the dermatologists. The authors consider such possibilities as different abilities in the clinical recognition of actinic keratoses, different perceptions as to which procedure leads to the best clinical outcome, and systematic differences and expectations in the types of patients consulting each specialty. All of these reasons probably play some role. However, I suspect that financial considerations play a significant and perhaps dominant role in explaining these differences.

Sadly, the medical remuneration system (hereinafter, "The System") rewards practitioners much more for not knowing what something is and then doing whatever is necessary to find out than for knowing what it is at a glance. Therefore, it is in the practitioner's best financial interest . . . [Full Text of this Article]

AUTHOR INFORMATION
Lawrence M. Lieblich, MD

RELATED ARTICLE

Differences in Biopsy Techniques of Actinic Keratoses by Plastic Surgeons and Dermatologists: A Histologically Controlled Pilot Study
Klaus Sellheyer and Wilma F. Bergfeld
Arch Dermatol. 2006;142(4):455-459.
ABSTRACT | FULL TEXT