Blue Cohosh

Bite my shiny metal...
7+ Year Member
Jun 14, 2010
64
18
Status
Pre-Medical
Hey practicing dermatologists, just wondering if there is a particular diagnosis or diagnoses that is (are) commonly missed (or mis-applied) by PCPs resulting in the unnecessary referral of patients to your office.

For example, are obvious seborheic keratoses frequently getting sent to you as rule out melanomas?

I'm just interested as a future PCP what common mistakes I can avoid :)

Thanks!
 
May 28, 2014
106
52
Status
Medical Student
Hey practicing dermatologists, just wondering if there is a particular diagnosis or diagnoses that is (are) commonly missed (or mis-applied) by PCPs resulting in the unnecessary referral of patients to your office.

For example, are obvious seborheic keratoses frequently getting sent to you as rule out melanomas?

I'm just interested as a future PCP what common mistakes I can avoid :)

Thanks!
how do you even know what a seborrheic keratosis is as a premed:eek:
 

Dral

10+ Year Member
Jan 8, 2009
1,847
1,026
Dermatomicroscope
Status
Attending Physician
I rarely mind outpatient referrals

As a resident however, I hated inpatient consults for bilateral LE cellulitis (aka stasis dermatitis)
Agree on both counts. A quick check to make sure a lesion is an SK and send the patient happily on their way is all good with me.

Red skin does not equal cellulitis. Sometimes in the right setting, but not always...or even a lot.

The other consult that's a bit annoying is the skin rash in the patient going to surgery, and you're called to make sure surgery can proceed. Sometimes, the rash is not even that close to where the person is going to be surgerized.
 

OPPforlife

10+ Year Member
5+ Year Member
Mar 18, 2009
226
18
Clemson SC
Status
Medical Student
Agree on both counts. A quick check to make sure a lesion is an SK and send the patient happily on their way is all good with me.

Red skin does not equal cellulitis. Sometimes in the right setting, but not always...or even a lot.

The other consult that's a bit annoying is the skin rash in the patient going to surgery, and you're called to make sure surgery can proceed. Sometimes, the rash is not even that close to where the person is going to be surgerized.
That sounds so unnecessary jeez


Sent from my iPhone using Tapatalk
 

Decicco

10+ Year Member
Jun 4, 2007
1,358
120
MN
Status
Resident [Any Field]
I agree- outpatient referrals are typically warranted. Inpatient consults typically could wait until the pt is discharged.
 
OP
Blue Cohosh

Blue Cohosh

Bite my shiny metal...
7+ Year Member
Jun 14, 2010
64
18
Status
Pre-Medical
What about the absolute must refers? Anything that you sometimes see too late because PCPs try to handle on their own rather than referring?
 

username456789

10+ Year Member
May 24, 2009
4,662
7,467
Status
Attending Physician
What about the absolute must refers? Anything that you sometimes see too late because PCPs try to handle on their own rather than referring?
I had an overweight patient with an established diagnosis of psoriasis (in classic extensor areas) who had been treated for 3 months for "yeast infection" of her crural folds and under her pannus with topical nystatin, topical ketoconazole, oral fluconazole, and oral terbinafine.

She presented to me and had obvious (to me) inverse psoriasis. She called me a week later to tell me that she was already feeling so much better with some clobetasol.

Not an emergency or anything, but this woman was nearly in tears from discomfort/itching, and nearly in tears on the phone out of gratitude.
 
  • Like
Reactions: DermViser

Dral

10+ Year Member
Jan 8, 2009
1,847
1,026
Dermatomicroscope
Status
Attending Physician
Yeah, the common thing is for us to get people that are failing one or more topical antifungals. I'm not a big fan of getting people who have been put on po antifungals for that sort of thing either...and I'm hoping primary care has gotten the po keto memo.