Dermatology is about sleuthing and putting things together that don't go together, says Lindy Fox, MD, founder of the interdisciplinary dermatology hospitalist consultation service at the University of California at San Francisco (UCSF). She recommends hospitalists learn basic descriptions of dermatological conditions, categories, and terminology. That way, when they make a phone presentation of symptoms to a consulting dermatologist, the specialist can determine whether the patient needs an in-person consultation.
Differential diagnosis of a dermatological condition considers history, duration, timing, waxing, and waning, Dr. Fox told participants in the hands-on Hospitalist Mini-College at UCSF last October.
"We worry about pain much more than about itching. We worry about medications and drug eruptions. A family history is important, and a social history, especially for patients who travel. But the most important thing is morphology," she says. "What is the primary lesion? Learn to recognize the primary lesion and the differential diagnosis will follow."
It is a concern that fewer dermatologists have any presence in the hospital, and the resulting demands on hospitalists will only increase, Dr. Fox says. At UCSF, she and two colleagues consult on patients who have skin diseases that are severe enough to require hospitalization, or who develop a cutaneous manifestation of the disease for which they were admitted or as a consequence of treatment of that disease. They closely collaborate with UCSF's hospitist service, as well as teach residents and, at the bedside, internists. This approach, however, is rare, mainly limited to academic medical centers, she says.
"There are young dermatologists out there who want to stay in the hospital and work with internists but the structure often isn't there," Dr. Fox says. "What hospitalists can do is help to facilitate these relationships for dermatologists who want to work in the hospital."