“Why don’t they ever call?”: Critical diagnoses in dermatopathology

Certain diagnoses in dermatopathology have significant implications for patient management, and on occasion appropriate clinical care may be facilitated by a phone call from the reporting dermatopathologist to the referring doctor. Whether or not this is appropriate may depend on a number of factors. While some groups have attempted to delineate which histological situations could be regarded as "critical" in general pathology1, 2 there are no guidelines specific to dermatology and no attempt has been made to assess perceptions among different clinical groups.
We designed a survey to assess the attitudes of pathologists, dermatologists, surgeons and general practitioners as to what circumstances warrant telephone contact in addition to a standard written report, as well as approaches to routine histology follow-up. The survey was distributed Australia-wide via a combination of specialist colleges, medical forums and collegiate contacts.
The responses to this survey have highlighted a number of clinical situations where the majority of medical practitioners believe a phone call from the dermatopathologist would be appropriate, and in certain circumstances such communication could have avoided adverse outcomes or “near misses”. With patient safety a priority, it is our hope that the results of this study will facilitate discussion and clearer delineation of critical diagnoses in dermatopathology.
1. Association of Directors of A, Surgical P, Silverman JF, et al. Critical diagnoses (critical values) in anatomic pathology. Hum Pathol. 2006; 37: 982-4.
2. Silverman JF, Pereira TC. Critical values in anatomic pathology. Arch Pathol Lab Med. 2006; 130: 638-40.

Dr. Jasmin Korbl