When in the hospital, insist on the Dermatologist!
By Dr. Neil S Sadik, MD
The increase of high quality dermatologic care offered at outpatient dermatology clinics, together with fewer hospital admissions of patients for cutaneous-only conditions, has resulted in an overall decrease and often disregard of the value of an inpatient dermatologic consult. Most often than not, internal medicine team members, plastic surgeons, neurologists and pediatricians take responsibility of diagnosing and treating the patient’s cutaneous manifestations.
Nevertheless, dermatology consultations play an important role in patient care in hospital settings with significant positive effects on clinical management and quality of life for the patient. Even though fewer patients are being admitted directly by dermatologists, a large percentage of patients have cutaneous diseases that need treatment or have cutaneous findings that may be important for diagnosis and choice of treatment of systemic diseases. Non-dermatologists have difficulties identifying, diagnosing, and assessing significance of skin findings in the context of other problems warranting admission, and clearly benefit from dermatology consultations since they have high educational clinical value.
There is a high percentage of an initial bedside diagnosis confirmed by subsequent biopsies that highlights the unique ability of dermatologists to make a diagnosis based solely on the initial physical exam. Particularly in the cases of rashes, examining the appearance of a rash, including morphology and distribution, and incorporating the patient’s history provides a dermatologist with enough information to make an accurate initial diagnosis to aid requesting services in diagnosing and treating hospital patients – even before biopsy results are available.
The most common skin conditions that occur in the hospital are presence of a rash, skin lesions, ulcers, blisters, and cellulitis, but are often not addressed by the patient’s primary medical team. Inclusion of a dermatologist consultation that prescribes topical and/or systemic steroids and antibiotics for the patient’s skin findings would most likely significantly impact the course, duration and success of treatment.
With recent healthcare changes stressing value-based care models and economic efficiency, dermatology consults make important contributions to patient care by correcting misdiagnoses and optimizing treatments. In the era of rising healthcare costs, the impact of dermatologists in the total cost of hospitalization with regards to decreasing length of stay, emergency room visits, readmission rates and patient overall quality of life should be closely evaluated and valued.
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