Most common unnecessary referral?

[Blue Cohosh]

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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!

 

[dermaway]

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😱

 

[asmallchild]

I rarely mind outpatient referrals

As a resident however, I hated inpatient consults for bilateral LE cellulitis (aka stasis dermatitis)

 

[Dral]

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]

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


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[Tamahawk]

GVHD vs Drug

 

[Dral]

Once I was consulted for a patient ADMITTED for bilateral arm cellulitis.

It was actually due to ACD/ICD from Lachydrin.

 

[Decicco]

I agree- outpatient referrals are typically warranted. Inpatient consults typically could wait until the pt is discharged.

 

[Blue Cohosh]

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]

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.

 

[Dral]

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.