Skin Health and Dermatology - News

21.08.06

Profit over patients

by Jeff Sommerfeld and Janelle Miles

SKIN cancer clinics are performing expensive, and often unnecessary, operations at three times the rate of medical specialists, who have accused the clinics of putting financial gain ahead of patient welfare.

The Australasian College of Dermatologists and Australian Society of Plastic Surgeons have warned that doctors working for skin cancer clinics are charging patients and Medicare for unnecessary, expensive operations and are working beyond their scope of expertise.

However University of Queensland Medical School deputy head David Wilkinson, who works one day a week in a skin cancer clinic, accused the specialists of attacking the clinics without evidence.

He said the university was researching the clinics and planned to publish the results before the end of the year.

College of Dermatologists honorary secretary Stephen Shumack said an article earlier this year published in the Medical Journal of Australia used information provided by skin cancer clinics that showed they were cutting out almost 29 moles before they picked up a single melanoma.

He said skin cancer clinics were also performing expensive and overly complicated skin flap repairs at three times the rate of trained dermatologists and specialist surgeons.

"The skin flap repair technique presents higher risk of infection and scarring for many patients if not performed expertly, and is unnecessarily complicated for small skin cancer excisions," Dr Shumack said.

"In most of those cases a simple, and cheaper, closure would have been more than adequate.

"We believe that many skin cancer clinics are more concerned with maximising income than improving patient care."

Skin cancer is the most common cancer in Australia, with general practitioners managing more than 800,000 patient encounters each year.

A recent article in the MJA identified that while historically GPs have managed most skin cancers, in recent years there has been a dramatic growth of skin cancer clinics.

"Little is known about these clinics; some include large corporate chains and others comprise smaller independent operators. Anecdotally, most doctors working in these clinics seem to be GPs, or at least non-specialist doctors," the article said.

Australian Society of Plastic Surgeons president Bill Cockburn said GPs played an important role in identifying and treating skin cancers.

However Dr Cockburn questioned the use of GPs in skin clinics.

"This is confusing to the general public who think they are seeing a specialist, whereas they are seeing a money-making machine rather than a proper medical service."

Professor Wilkinson said the University of Queensland was researching skin cancer clinics so patients could make their own"rational judgments".

"I'm not in the business of defending anybody. I'm in the business of doing research and presenting data and let the scientific community decide," he said.

(Courier-Mail, 21 August 2006)