Most common unnecessary referral?

Discussion in 'Dermatology' started by Blue Cohosh, 09.26.14.

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  1. Blue Cohosh

    Blue Cohosh Bite my shiny metal... 5+ Year Member

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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!
     
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  3. dermaway

    dermaway

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    how do you even know what a seborrheic keratosis is as a premed:eek:
     
  4. asmallchild

    asmallchild Lifetime Donor SDN Moderator 10+ Year Member

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    I rarely mind outpatient referrals

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

    Dral 7+ Year Member

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    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.
     
  6. OPPforlife

    OPPforlife 5+ Year Member

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    That sounds so unnecessary jeez


    Sent from my iPhone using Tapatalk
     
  7. Tamahawk

    Tamahawk 5+ Year Member

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    GVHD vs Drug
     
  8. Dral

    Dral 7+ Year Member

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

    It was actually due to ACD/ICD from Lachydrin.
     
  9. Decicco

    Decicco 7+ Year Member

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

    Blue Cohosh Bite my shiny metal... 5+ Year Member

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    What about the absolute must refers? Anything that you sometimes see too late because PCPs try to handle on their own rather than referring?
     
  11. username456789

    username456789 SDN Bronze Donor Bronze Donor 7+ Year Member

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    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.
     
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  12. Dral

    Dral 7+ Year Member

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    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.
     

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