The American Board of Dermatology defines a dermatologist as “a physician who is trained to evaluate and manage pediatric and adult patients with benign and malignant disorders of the skin, hair, nails and adjacent mucous membranes.”1 According to the American Academy of Dermatology, “a dermatologist is a physician who has expertise in the diagnosis and treatment of patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases.”2 Many physicians, foreign and U.S. medical graduates alike, claim to be “dermatologists” even though they have no training in the field whatsoever.
In 2005, this issue was brought to the forefront in North Carolina. A physician board certified in family medicine had her North Carolina Medical License suspended for, among other reasons, creating “a false impression with the public” that she was “board certified’ in dermatology”.3 This particular physician also performed multiple procedures, “including cosmetic fillers Perlane and Restylane prior to those products being approved by the United States Food and Drug Administration.”3 Regardless of the reasons why this or other physicians want to practice dermatology, this misrepresentation is absolutely unethical.
When Expertise Matters
This isn’t simply a turf war — board-certified dermatologists really are better at dermatology than other physicians.
Bergfeld and Sellheyer correlated clinical impressions of cutaneous lesions of family physicians, plastic, general and orthopedic surgeons, internal medicine doctors and pediatricians versus dermatologists with the histological diagnosis of these lesions.
Overall, dermatologists diagnosed almost twice as many lesions correctly when compared to non-dermatologists (75% vs. 40%, respectively).4
These authors also compared biopsy techniques of actinic keratoses used by dermatologists and plastic surgeons. Plastic surgeons were much more likely to perform excisional biopsies of these lesions than dermatologists (50.5 % vs. 1.4%, respectively).5 Surgical excisions of these extremely common lesions not only increases the overall medical care cost, but also may put patients under completely unnecessary risks, such as longer anesthesia and higher chance of cutaneous infection.
Many physicians, including family doctors, internists and pediatricians, take very good care of patients with dermatological diseases. Examination of the skin and mucous membranes is an integral part of any comprehensive physical examination, and many physicians are also trained to perform skin biopsies. Personally, I think this is great. I have no problem with primary care doctors taking care of simple dermatological issues and referring patients to a dermatologist only if it is a difficult case.
The Importance of Specialists
However, there cannot be any misrepresentation on the part of the physician. Every patient should be given an option of seeing a specialist who really is a specialty-trained, board-certified physician. It is not okay, in my opinion, for any physician to call him/herself a “dermatologist” simply because he or she has an interest in the field, especially when this claim has purely financial motivation.
Dr. Goldenberg, Section Editor of Issues in Dermatology, is a Dermatopathology Fellow at the University of Colorado Health Sciences Center, Department of Pathology, in Denver, CO.
Seeing the Good Side of our Colleagues
By Steven R. Feldman, M.D., Ph.D.
I have tremendous confidence in the skills of my dermatologist colleagues. I regularly see their commitment to their patients and our specialty. Like Dr. Goldenberg, I think it means something to be a “dermatologist” and believe it is wrong for a doctor to try to mislead patients.
I wonder, though, if Dr. Goldenberg goes too far in impugning the motivation of medical colleagues in other disciplines. Is there evidence that “many physicians, foreign and U.S. medical graduates alike, claim to be ‘dermatologists’ even though they have no training in the field whatsoever”? Unless there’s good evidence to the contrary, I think it is wrong to suggest that other physicians’ acts are based on “purely financial motivation”; we all have financial motivations, but it seems to me that physicians are largely driven by a desire to improve the lives of their patients.
There is a strong tendency to see our colleagues’ mistakes and never see their successes. Such experiences seem to bolster the all-too-human tendency to think the worst of others. We’ll all agree it is wrong to mislead patients about one’s training and experience. It may also be wrong to believe the worst of colleagues and to assume a priori that they are acting outside of their capabilities and training.
Dr. Feldman, Chief Medical Editor, is in the Department of Dermatology at Wake Forest University Baptist Medical Center in Winston-Salem, NC.
The American Board of Dermatology defines a dermatologist as “a physician who is trained to evaluate and manage pediatric and adult patients with benign and malignant disorders of the skin, hair, nails and adjacent mucous membranes.”1 According to the American Academy of Dermatology, “a dermatologist is a physician who has expertise in the diagnosis and treatment of patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases.”2 Many physicians, foreign and U.S. medical graduates alike, claim to be “dermatologists” even though they have no training in the field whatsoever.
In 2005, this issue was brought to the forefront in North Carolina. A physician board certified in family medicine had her North Carolina Medical License suspended for, among other reasons, creating “a false impression with the public” that she was “board certified’ in dermatology”.3 This particular physician also performed multiple procedures, “including cosmetic fillers Perlane and Restylane prior to those products being approved by the United States Food and Drug Administration.”3 Regardless of the reasons why this or other physicians want to practice dermatology, this misrepresentation is absolutely unethical.
When Expertise Matters
This isn’t simply a turf war — board-certified dermatologists really are better at dermatology than other physicians.
Bergfeld and Sellheyer correlated clinical impressions of cutaneous lesions of family physicians, plastic, general and orthopedic surgeons, internal medicine doctors and pediatricians versus dermatologists with the histological diagnosis of these lesions.
Overall, dermatologists diagnosed almost twice as many lesions correctly when compared to non-dermatologists (75% vs. 40%, respectively).4
These authors also compared biopsy techniques of actinic keratoses used by dermatologists and plastic surgeons. Plastic surgeons were much more likely to perform excisional biopsies of these lesions than dermatologists (50.5 % vs. 1.4%, respectively).5 Surgical excisions of these extremely common lesions not only increases the overall medical care cost, but also may put patients under completely unnecessary risks, such as longer anesthesia and higher chance of cutaneous infection.
Many physicians, including family doctors, internists and pediatricians, take very good care of patients with dermatological diseases. Examination of the skin and mucous membranes is an integral part of any comprehensive physical examination, and many physicians are also trained to perform skin biopsies. Personally, I think this is great. I have no problem with primary care doctors taking care of simple dermatological issues and referring patients to a dermatologist only if it is a difficult case.
The Importance of Specialists
However, there cannot be any misrepresentation on the part of the physician. Every patient should be given an option of seeing a specialist who really is a specialty-trained, board-certified physician. It is not okay, in my opinion, for any physician to call him/herself a “dermatologist” simply because he or she has an interest in the field, especially when this claim has purely financial motivation.
Dr. Goldenberg, Section Editor of Issues in Dermatology, is a Dermatopathology Fellow at the University of Colorado Health Sciences Center, Department of Pathology, in Denver, CO.
Seeing the Good Side of our Colleagues
By Steven R. Feldman, M.D., Ph.D.
I have tremendous confidence in the skills of my dermatologist colleagues. I regularly see their commitment to their patients and our specialty. Like Dr. Goldenberg, I think it means something to be a “dermatologist” and believe it is wrong for a doctor to try to mislead patients.
I wonder, though, if Dr. Goldenberg goes too far in impugning the motivation of medical colleagues in other disciplines. Is there evidence that “many physicians, foreign and U.S. medical graduates alike, claim to be ‘dermatologists’ even though they have no training in the field whatsoever”? Unless there’s good evidence to the contrary, I think it is wrong to suggest that other physicians’ acts are based on “purely financial motivation”; we all have financial motivations, but it seems to me that physicians are largely driven by a desire to improve the lives of their patients.
There is a strong tendency to see our colleagues’ mistakes and never see their successes. Such experiences seem to bolster the all-too-human tendency to think the worst of others. We’ll all agree it is wrong to mislead patients about one’s training and experience. It may also be wrong to believe the worst of colleagues and to assume a priori that they are acting outside of their capabilities and training.
Dr. Feldman, Chief Medical Editor, is in the Department of Dermatology at Wake Forest University Baptist Medical Center in Winston-Salem, NC.
The American Board of Dermatology defines a dermatologist as “a physician who is trained to evaluate and manage pediatric and adult patients with benign and malignant disorders of the skin, hair, nails and adjacent mucous membranes.”1 According to the American Academy of Dermatology, “a dermatologist is a physician who has expertise in the diagnosis and treatment of patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases.”2 Many physicians, foreign and U.S. medical graduates alike, claim to be “dermatologists” even though they have no training in the field whatsoever.
In 2005, this issue was brought to the forefront in North Carolina. A physician board certified in family medicine had her North Carolina Medical License suspended for, among other reasons, creating “a false impression with the public” that she was “board certified’ in dermatology”.3 This particular physician also performed multiple procedures, “including cosmetic fillers Perlane and Restylane prior to those products being approved by the United States Food and Drug Administration.”3 Regardless of the reasons why this or other physicians want to practice dermatology, this misrepresentation is absolutely unethical.
When Expertise Matters
This isn’t simply a turf war — board-certified dermatologists really are better at dermatology than other physicians.
Bergfeld and Sellheyer correlated clinical impressions of cutaneous lesions of family physicians, plastic, general and orthopedic surgeons, internal medicine doctors and pediatricians versus dermatologists with the histological diagnosis of these lesions.
Overall, dermatologists diagnosed almost twice as many lesions correctly when compared to non-dermatologists (75% vs. 40%, respectively).4
These authors also compared biopsy techniques of actinic keratoses used by dermatologists and plastic surgeons. Plastic surgeons were much more likely to perform excisional biopsies of these lesions than dermatologists (50.5 % vs. 1.4%, respectively).5 Surgical excisions of these extremely common lesions not only increases the overall medical care cost, but also may put patients under completely unnecessary risks, such as longer anesthesia and higher chance of cutaneous infection.
Many physicians, including family doctors, internists and pediatricians, take very good care of patients with dermatological diseases. Examination of the skin and mucous membranes is an integral part of any comprehensive physical examination, and many physicians are also trained to perform skin biopsies. Personally, I think this is great. I have no problem with primary care doctors taking care of simple dermatological issues and referring patients to a dermatologist only if it is a difficult case.
The Importance of Specialists
However, there cannot be any misrepresentation on the part of the physician. Every patient should be given an option of seeing a specialist who really is a specialty-trained, board-certified physician. It is not okay, in my opinion, for any physician to call him/herself a “dermatologist” simply because he or she has an interest in the field, especially when this claim has purely financial motivation.
Dr. Goldenberg, Section Editor of Issues in Dermatology, is a Dermatopathology Fellow at the University of Colorado Health Sciences Center, Department of Pathology, in Denver, CO.
Seeing the Good Side of our Colleagues
By Steven R. Feldman, M.D., Ph.D.
I have tremendous confidence in the skills of my dermatologist colleagues. I regularly see their commitment to their patients and our specialty. Like Dr. Goldenberg, I think it means something to be a “dermatologist” and believe it is wrong for a doctor to try to mislead patients.
I wonder, though, if Dr. Goldenberg goes too far in impugning the motivation of medical colleagues in other disciplines. Is there evidence that “many physicians, foreign and U.S. medical graduates alike, claim to be ‘dermatologists’ even though they have no training in the field whatsoever”? Unless there’s good evidence to the contrary, I think it is wrong to suggest that other physicians’ acts are based on “purely financial motivation”; we all have financial motivations, but it seems to me that physicians are largely driven by a desire to improve the lives of their patients.
There is a strong tendency to see our colleagues’ mistakes and never see their successes. Such experiences seem to bolster the all-too-human tendency to think the worst of others. We’ll all agree it is wrong to mislead patients about one’s training and experience. It may also be wrong to believe the worst of colleagues and to assume a priori that they are acting outside of their capabilities and training.
Dr. Feldman, Chief Medical Editor, is in the Department of Dermatology at Wake Forest University Baptist Medical Center in Winston-Salem, NC.
