[Histonet] Out-of-hospital labs comment on OVERUTILIZATION of "hyphens"

[Andrew Burgeson]

I think its pretty obvious that we are all talking about
o-v-e-r-u-t-i-l-i-z-a-t-i-o-n, just as the "hyphen" is so
overutilized in your post!   

Please tell me ALL about how dermatologists overutilize.
What is the metric? How are GI and Urol and dermatology the
same? I would like to show some dermatologists I know. 

There are other polarities to this debate... other
"facets,"if you will. What do you have to say about
"choice?" What do you have to say about clinico-pathologic
correlations? Dermatologists are very concerned about who
reads their labs. Very. If you do not believe me, then ask a
few? Some hospital groups have
dermatologist/dermatopathologists that are GREAT!!!!! But
not all, unfortunately. (Some of the best ones I know of are
in hospital settings...and get lots of derm work! World
class dermpaths)

Also, unlike GI, for example, IS THERE AN AVERAGE biopsy
rate? One of the biggest problems with this whole line of
discussion is that people are aggregating
dermatology/dermatopathology with GI and Urology.
THEY-ARE-ALL-DIFFERENT. I would like to point out that there
are more named diseases in dermatology than any other system
or organ....by far.50 pages of CPTs. One mole, one nail, one
seb k? Should the dermatologist leave off areas of concern
because people are going to say that they are overutilizing?
Why havent the hospital groups complained to the clinicians
that THEY serve when "too many" (whatever that means)
specimens come in? (Hospital labs even do slide preparation
for local clinician dermatopathologists sometimes.) What say
you in that instance?  There are ALL kinds of permutations
to this stuff. It is not all biopsies, either...lots of
surgicals. We could get into MOHS surgeons vs plastic
surgeons and how in bed they are seen to be with hospital
labs if you like, but that will take a lot more time. Maybe
you should ask some of them why they choose to manage
melanomas?

Many dermatologists keep labs in house because they feel
they can better diagnose and consequently serve the patient.
Also, in case you are unaware, dermatology residencies are
typically very heavy in histology, due to the fact that
there is a significant pathology component on the clinical
board test. This makes many clinical dermatologists quite
savvy with dermpath. This is yet another distinction. Often
clinical dermatopathologists who train clinician residents
gain their loyalty and confidence, resulting in getting
their work.

 Melanocytic and inflammatory skin cases are typically more
difficult to diagnose, and so these groups often either hire
a fellowed dermpath who can read that stuff, or they have to
find someone willing to read hard cases and that can be
difficult. 

I am confident that dermatologists are quite
capable of deciding who they should send their lab work to
and that they are capable of getting precision reports based
on their needs and their decisions. I know because I have
seen it and I have heard it time and time again. I have also
seen many initial bx reports from general path labs that are
totally misdiagnosed, and the patient's life potentially
saved because the dermatologist and dermpath correctly
diagnosed the lesion as MM. What about that? Next time a
primary care physician wants to take a mole off you or your
loved one, think twice and then think even harder about
where that bx will be tested. I know where I would want it
to go.

Furthermore, there are many types of physicians out there
(predominately some family practice and other primary care
practitioners)other than dermatologists who improperly
excise dangerous melanocytic proliferations, most often by
not excising deeply enough, and causing the histologic
results on re-excision to be difficult to interpret due to
the base of the original biopsy site having too many
lymphocytes present to classify the disease and measure its
depth.

If you care...as it seems you genuinely DO...I think you are
a good person. I am sure you are ethical and try to do the
very best for the patient and to protect the physicians
(perhaps you are one)from unnecessary liability. Your
comment is taken in and has validity, but I believe requires
clarification. Many dermatologists I am certain would find
that to be an
insult and a gross misrepresentation of what they do.

Best wishes kind sir.

Regards,

AB