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The UK needs office dermatologists

BMJ 2012; 345 doi: (Published 10 September 2012) Cite this as: BMJ 2012;345:e6006

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Re: The UK needs office dermatologists

It would be great to have easy access to a dermatologist. Whether it is a good use of a scarce resource for all skin related problems to go straight there is more open for debate. Certainly very few GP consultations now are limited to one 'body system' so the dermatology component may be alongside a review of heart failure, knee pain and worries re hearing. Recent melanomas in my practice did not present as a skin problem but were spotted when the patient was seen for other reasons. The daily collection of skin lump examinations for lumps and bumps leads to a need for a dermatologist in a very small percentage unless you want to be seeing dermatofibromas seborrhoeic warts, viral warts, mild acne vulgaris, nails that may be fungal, etc. I would love though to be able to get the difficult dermatosis, the bizarre rashes, etc, seen in real time by someone in the same 'office' at the same time.

You mention the scarcity of postgraduate training, and this is a problem in all of the things we see. Perhaps though dermatology is less bad than other disciplines with a significant number of doctors having done one of the diploma courses. I agree though we could and should do better.

I would be happy not seeing any more toothaches though--why patients see their GPs for this is, however, important and relevant. One reason is cost: we don't cost the patient at the time. Another is convenience: we are there every day, including on call Saturday and Sunday, and sometimes the toothache has a medical cause.

Competing interests: Current nhs policy is for all GPs to reduce referrals

17 September 2012
nicholas sharvill
balmoral surgery Deal UK
balmoral surgery