Clinical ArticlesMedical Students / JMOs

Making a good dermatology referral over the phone

There are a few words a dermatologist likes to hear over the phone and which will indicate that you have at least some minute interest in the specialty. It’s like a mental diagnostic flow chart that allows the person on the other end of the phone to start thinking about the possible causes for the problem that you are describing. No the word is not ‘rash’ or ‘lesion’ or anything vague like that. First of all, is what you are seeing red and scaly or red and non-scaly? Or is the rash pustular/blistering/vesicular? By using terminologies like these you are leading the dermatologist over the phone down a certain diagnostic pathway and hence also treatment pathway. Not to mention they will be greatly impressed.
From a history perspective, it is not dissimilar to how you would present any other medical case (history of presenting complaint/past medical history/medication/social history/physical examination…) But in addition to this, the words to describe the morphology of the actual problem is the most tricky bit.

So here are the acronyms that I use and feel free to make up your own:

Red and Scaly
PMS PETAL (or Prime Minister’S cat PETAL)
Psoriasis
Mycosis fungoides
Solar damage

Pityriasis rosea
Ezcema
Tinea
Annulare granulma
Lupus

Red and Non-scaly
CUL DVA EVIE(or C U Later at the Department of Veteran Affairs EVIE)
Cellulitis
Urticaria
Lichen planus

Drug reaction
Viral or bacterial infection
Annulare erythema
Erythema multiforme
Vasculitis
Infiltrates
Erythema nodosum

Blistering
ICI(International Chemical Industry)
Infective
Contact dermatitis
Inflammatory and immunological

Pustular
II (II captain)
Infective
Inflammatory

You do not have to come to the correct diagnosis but it’s good to be able to paint an accurate picture and be the eyes for the person that you are talking to on the phone. Dermatology is of course one of the most (if not the most) visually oriented specialties.

In the coming weeks, we will go through each acronym in greater detail. Next time, we will look at the common topical steroid agents used in dermatology.

Until next time,

Darier

P.S: Darier is not my real name but it’s the name of a famous French dermatologist. Guess which skin disease he described?

Bravo!<br />
<br />
EDIT:<br />
Was thinking, in your opinion, what would constitute a good referral regarding a case of Acne Vulgaris? Would it be appropriate to recommend to the Dermatologist that the patient may need a 6 month course of Isotretinoin, or solely allow them to make the decision?
    With acne, there is mild, moderate and severe. <br />
    <br />
    1. Mild - open and closed comedones (i.e blackheads and whiteheads). Don't really need isotretinoin. Bit of an overkill. <br />
    2. Moderate - inflammatory papules. May need isoretinoin if there is significant psychological distress. <br />
    3. Nodulocystic - nodules and cysts, has significant potential to develop scarring. Would need isoretinoin (or roaccutane) if no contraindications (e.g pregnancy or intending to be pregnant, uncontrolled hyperlipidaemia etc)<br />
    <br />
    The decision to start roaccutane can be tricky because even if the acne is mild, there may be significant psychological distress to warrant commencing the medication. There is a form of acne called Acne Excorie whereby the patient is picking at the acne (which may initially have been mild) and this produces a characteristic morphological presentation and the patient may be at risk of developing scarring. Dermatologists usually would prescribe the medication for these patients who tend to be females. <br />
    <br />
    I will go through acne later on but it certainly is one of the classic dermatological problems, up there with psoriasis and ezcema. In your referral, it's always worthwhile mentioning how the patient is psychologically/socially affected by the acne because that will impact the dermatologist's decision to prescribe the drug. I wouldn't make any recommendations though and roaccutane doesn't have to be a 6 month course.
Great article!
such complicated wording- when will the medical world realise it may well be much easier to take a picture and send it from computer-computer or even phone to phone!
    <blockquote>such complicated wording- when will the medical world realise it may well be much easier to take a picture and send it from computer-computer or even phone to phone!</blockquote><br />
    I realise that you're joking around but remember taking pictures of patients and sending them phone to phone could constitute an infringment of their privacy and confidentiality. There is too much potential for abuse of a hypothetical system like that... sad but true.<br />
    <br />
    Anyways, I thoroughly enjoyed the blog/article! very informative and may I ask the poster darrier ...are you a dermatologist yourself (or dermatology trainee/registrar)?
    <blockquote>such complicated wording- when will the medical world realise it may well be much easier to take a picture and send it from computer-computer or even phone to phone!</blockquote><br />
    <br />
    Registrars often take photos of things to show their consultants.
      <blockquote>Registrars often take photos of things to show their consultants.</blockquote><br />
      <br />
      <br />
      Obviously with consent.
Usually it's implied consent
P