Recent changes in the practice of medicine in this country have occurred because third-party insurance carriers can restrict their insured persons from seeing some specialists before they see their "primary care provider." People with dermatologic concerns will be seen first in pediatric, family practice, and in some internal medicine practices. Nurses who are knowledgeable about primary and secondary skin lesions and the specific terminology used to describe them can help the practitioner to make an accurate diagnosis, creating better patient outcomes and less morbidity. Additionally, the nurse can use this understanding to better instruct the patient in self-care measures, including how to avoid recurrences of the skin problem.
A better understanding of dermatologic conditions by primary care providers should underscore the subtleties inherent in the specialty. Even in common situations, such as the management of acne, the best results for the patient in terms of improvement of symptoms, shortening the course of treatment, and fewer permanent side effects, such as scars, could be expected through management by the best-educated specialist, the dermatologist.
Due to the fact that the skin is so visible and people often know when something has changed with their skin, the point can be made that dermatologists should be considered as primary care providers. Additionally, there are potentially serious, even life-threatening conditions identifiable by the dermatologist that the lay person and even another doctor might not recognize (Kirsner & Federman, 1995). As long as the people who are paying for health insurance have no authority to select the plans they are paying for, most people will have to endure some degree of restricted access to medical care.
It is unfair and unrealistic to expect general providers to develop expertise in many specialties, especially when this country has so many well-educated specialists. However, as long as today's health care insurance system prevails, it will be helpful for the nurse to become more knowledgeable about skin conditions that may cause patients to seek medical care.
The print version of this article was originally certified for CE credit. For accreditation details, contact the publisher. Jannetti Publications, Inc. East Holly Avenue Box 56, Pitman, NJ; phone (856) 256-2300.
Ms. Cole wishes to acknowledge and thank Drs. Jonathan Gold, Sammy Hutman and Roy Stern of The Dermatology Center of North Jersey, Clifton, NJ, for many years of generous teaching and for sharing their dermatological expertise and wisdom. Their encouragement was indispensable during the years of study toward becoming a Nurse Practitioner. Thank you so much. She also wishes to thank Dr. Christopher Sciales and the dermatologists of Livingston and Warren Dermatology, NJ, for their kindness and continued support of her as she begins her Nurse Practitioner career.
Dermatology Nursing. 2002;14(6) © 2002 Jannetti Publications, Inc.
Cite this: Necessary Elements of a Dermatologic History and Physical Evaluation - Medscape - Dec 01, 2002.