Large variations in terms of health care organisation

Countries differ greatly in the way in which their health services deal with skin disorders. These variations are roughly indicated by the number of dermatologists, ranging (in Europe) from about 1 per 20 000 patients in Italy and France to 1 per 150 000 patients in the UK.

In general, only a minority of people with skin diseases seek medical help while many opt for self-medication. Pharmacists have a key role in advising the public on the use of over-the-counter products. Primary care physicians seem to treat the majority of people among those seeking medical advice. Primary care of dermatological problems is not precisely defined and overlaps with specialist activity. Everywhere the dermatologist's workload is concentrated in the outpatient department. Despite the vast number of skin diseases, just a few categories account for about 70% of all dermatological consultations.

Generally speaking, dermatology requires a low technology clinical practice. Clinical expertise depends mainly on the ability to recognise a skin disorder quickly and reliably which, in turn, depends largely on awareness of a given clinical pattern based on previous experience, and on the practised eye of a visually literate physician.18 The process of developing "visual skill" and a "clinical eye" is poorly understood and these skills are not formally taught.

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