Is enough dermatology training given to primary health physicians?

ABSTRACT

Large numbers of patients with minor skin ailments are being referred by primary health physicians to skin clinics with little attempt at diagnosing and treating these cases. This study evaluated whether primary health physicians were exposed to enough dermatology in their training to diagnose and treat simple dermatoses. In this retrospective cross-sectional survey the diagnosis, treatment, source of referral of all patients seen between January and June 1997 in two health centres in East Trinidad, Sangre Grande (SG) and Arima (A), were reviewed. There werer 146 registered patients at Sangre Grande and 189 at Arima. The commonest skin disorder was eczema (SG 37 percent, A 38 percent). The ability to diagnose this condition was 25 percent in Arima and 7 percent in Sangre Grande. Atopic exzema was the commonest in childhood (A 16 percent, SG 13 percent). Fungal infections, which included tinea corpois (A 8 percent, SG 7 percent) and tinea capitis ( A 15 percent, SG 8 percent), were the next most common dermatoses seen. The diagnostic ability for tinea corpois was A 13 percent SG 0 percent; but there was a higher diagnostic index for tinea capitis (A 52 percent, SG 50 percent). Psoriasis (A 21 percent, SG 7 percent), like tinea capitis, had a diagnosis index of 50 percent. The most common referring diagnosis was skin rash (43 percent, SG 45 percent) or fungal rash (A 38 percent, SG 36 percent). There were significant differences in gender (P <0.05) and ethnicity (P<0.001) in Arima. In conclusion, the commonest dermatoses seen in both centres, were the eczemas, fungal infections and psoriasis. Diagnostic ability was low for the eczemas and tinea corporis, the commonest skin disorders, but better for tinea capitis and psoriasis. Increase referrals fof common skin disorders leads to overcrowding, decreasing the time for the dermatologist to do procedures, to teach and to give earlier and more frequent appointments to needy patients. Cost of treatment of patients and to Government is lower when the diagnosis is made on the initial visit, and loss of school days for tinea capitis can be decreased by prompt and effective treatment.(AU)