The Cost-effectiveness of Primary Care:  A Myth or a Reality?

The article entitled "The Ability of Primary Care Physicians to Recognize the Common Dermatoses" (see p 620) raises some provocative issues and suggests a number of questions that require answers. Clearly, these studies need to be verified under other circumstances and with different formats, since those who will have a tendency to discredit the findings will question whether the simple recognition of pictures of skin diseases is an adequate or fair method of assessing dermatologic diagnostic competency. This technique, however, is a standard method currently employed by a number of speciality boards.

The preliminary study by Ramsay and Fox strongly supports the contention that primary care physicians are not well equipped to identify a substantial percentage of the 20 most common dermatologic disorders in comparison with the performance of a control group of dermatologists. This is a most discouraging observation, since Stern et al¹ present evidence that visits to