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Issues in Dermatology
February 1999

Fire Your Dermatopathologist!

Arch Dermatol. 1999;135(2):137-138. doi:10.1001/archderm.135.2.137

Don't do it quite yet. Read on. Imagine a family practitioner. This good doctor examines patients with a panoply of problems, including those who suffer from skin diseases. The good doctor was indeed trained in residency to deal with the full gamut of human disease, including lectures on dermatologic problems and even a rotation through the dermatology clinic at his/her hospital. When the good doctors encounter a patient with a difficult cutaneous condition they do not refer the patient to the respected dermatologist in their office building who in their judgment is most qualified to deal with the conundrum. Instead, they have found a dermatologist who is willing to accept a fee from them instead of letting the dermatologist bill the patient or their insurance. The fee that the dermatologist bills the good doctor is far less than, indeed only a fraction of, what the good doctor can collect from the patient or their insurance for taking care of the skin problem. Instead of receiving 2 bills, 1 from the family practitioner and 1 from the dermatologist, the patient only gets a single bill. Life is good! But hold, you, dear reader, are a dermatologist. You may perceive a conflict of interest. You may even be angered that a generalist exploits dermatologists in such a manner, or that dermatologists makes themselves available for such exploitation. Or, if you do not want to rush to judgment, you may ponder questions such as these: Is this pattern of referral in the best interest of the patient? Would a dermatologist who accepted such a situation likely be the best one available, or even a good one? If physicians make arrangements like these, do they risk betraying their fiduciary duties to patients, and jeopardize the regard in which they are held by the rest of society?

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