Public health

Hospital-based dermatologists needed to improve patient care: Prof Fernandez-Peñas


Prof Pablo Fernandez-Peñas

A Sydney-based dermatologist is calling for more hospital-based practitioners after his research showed they significantly improve inpatient care.

Westmead Hospital Department of Dermatology Head Professor Pablo Fernandez-Peñas co-investigated outcomes for 306 inpatient dermatology consultations between June 2018 and November 2019.

Published in the International Journal of Dermatology, his study found that the primary inpatient team made “no attempt” at diagnosing, or listing potential differentials for, skin lesions in 44% of cases and failed to initiate management for 63%.

Where provisional diagnoses were made, dermatologists changed them 58% of the time. They also initiated or changed management in 82% of all cases.

Professor Fernandez-Peñas said the disparity in diagnosis and management rates could reflect the primary team’s minimal exposure to dermatology education and training.

“Only four out of 18 medical schools have dermatology as a compulsory topic and the number of lectures about dermatology that most clinicians listen to in Australia is three,” he told the limbic.

“More than 50% of the doctors that are working now as GPs, cardiologists, immunologists, rheumatologists, etc. have never seen a patient with a dermatologist.”

Dermatitis, infection and drug reactions made up the bulk of initially undiagnosed cases, the study showed.

Meanwhile, infections were overestimated and dermatitis was underestimated in provisionally diagnosed cases.

Of 18 cellulitis and seven scabies cases identified by the primary inpatient team, only six and five cases were backed by dermatologists, respectively. However, five additional scabies cases missed by the primary team were detected by dermatologists.

Primary team-treated patients most commonly received systemic antibiotics or antihistamines, while dermatologists mostly prescribed topical steroids and emollients and only recommended systemic antibiotics in 5% of patients.

This has “​​significant infection control implications for staff, family, and patients themselves”, the authors wrote.

“Dermatology’s role in recognising the cutaneous manifestation of these conditions is vital to ensure judicious use of antibiotics, to decrease the length of stay for patients, and to prevent unnecessary spread of infectious conditions such as scabies; this can prevent significant reductions in the quality of life of patients and decrease healthcare expenditure,” the study authors said

As a result, Professor Fernandez-Peñas believes all skin-related events should be reviewed by a dermatologist, just as cardiologists manage heart conditions.

“If there’s something on the skin in the hospital, that should be reviewed by a dermatologist. So there should be enough dermatologists in the hospital so any skin condition is reviewed, not mismanaged by other teams on their own thinking,” he said.

“Some local health districts think that dermatology is not needed in the hospital, because we are just an ‘outpatient’ specialty.”

“They don’t understand that dermatology in hospitals, helping with consults, helping with inpatients, helping in ED is very effective, could solve a lot of issues,” he concluded.

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