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August 1994

Dermatologic Consultations—How Can We Know If We Are Effective?Initial Methodologic Considerations for the Critical Assessment of Medical Interventions Performed by Physicians

Author Affiliations

Department of Dermatology University Hospitals of Cleveland Cleveland Veterans Affairs Medical Center 11-G (W) 10701 East Blvd Cleveland, OH 44106

Arch Dermatol. 1994;130(8):1052-1054. doi:10.1001/archderm.1994.01690080118019

I CAN WRITE WITH some experience about dermatologic consultations, since I requested so many while still an internist. Risking national ridicule, I will relate one of my experiences. Wondering if a patient with ''osteoarthritis'' and a scaly plaque perhaps had psoriasis and psoriatic arthritis, I began treating her with a midpotency topical corticosteroid and asked a dermatologist to see her. The consultation note, which was a treatise repeating the lengthy history that I knew, ended with ''Imp: LSC. Rec: Fluocinonide cream 0.05% bid.'' (a higher-potency topical corticosteroid). Once I had translated the abbreviation and looked up lichen simplex chronicus to learn that it is a localized plaque created by repeated scratching, I am sure that the consultants and I differed about the value of this consultation and my knowledge of simple skin diseases. True, the diagnosis had changed, the therapy had changed, and I had been wrong, but I was

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