Background: Skin diseases are a frequent reason for advice in general practitioners’ practices. Furthermore, there is hardly any data on the collaboration between general practitioners and dermatologists in Central Europe. In addition to the question of cooperation with dermatologists, we examined the attitudes of general practitioners towards topical cortisone therapy and skin cancer screening.
Method: In semi-structured interviews (20–40 min), 14 general practitioners from urban and rural areas were asked about their personal approach to diagnosis, therapy and coordination of patients with skin diseases. This was done using sample patients that the doctors recalled. The interviews were recorded, verbatim transcribed and qualitatively analyzed by two independent investigators after creating a coding tree.
Results: In the cooperation with the dermatologists, the difficulty of making appointments promptly and the lack of professional feedback were the main issues. With the administration of cortisone there were three distinct types of users; topical therapy is often initiated by general practitioners. With regard to skin cancer screening, there was a very heterogeneous attitude of the doctors surveyed, ranging from enthusiastic approval to strict rejection.
Conclusions: The collaboration between general practitioners and dermatologists still needs to be optimized, especially in communication and division of labor. General practitioners would also benefit from clear recommendations on differentiated cortisone therapy for common skin diseases. Internationally established approaches such as teledermatology or regular consultation hours by a dermatologist in the premises of the family doctor’s practice could be established as model projects.
Skin diseases are a frequent reason for advice in outpatient care. Depending on the study and country, these represent 6% to max. 24% of the outpatient consultation occasions in the family doctor’s practice [1–4]. According to the CONTENT study, skin diseases are the fifth most common reason for advice in the context of family doctor care in Germany . The most common reasons for advice or diagnoses made are eczema, infectious skin diseases, lesions suspected of melanoma and benign tumors .
In the Netherlands, 65% of patients with a skin disease initially only consult their family doctor for further clarification; only 1.6% only used a dermatologist .
In his function as the first point of contact, it is up to the family doctor to sift through these patients and decide whether they need immediate treatment or referral . Various international studies show referral rates of 31–38% to a dermatologist [6, 7] and in a survey carried out in Germany, referrals to a dermatologist due to dermatological complaints were among the top group in the percentage distribution of referrals to various disciplines .
The high prevalence of dermatological diseases contrasts somewhat with the basic and advanced training and the resulting clinical skills of general practitioners in the field of dermatology . Most general practitioners have not enjoyed any further structured training here apart from the courses that are compulsory in medical studies. It is not surprising that, at least in Great Britain, dermatological topics are regularly mentioned when general practitioners are asked about training priorities  and the fact that there is hardly any general dermatological research is criticized .
In ZFA 4/2015 we reported on the decision-making strategies in this field [10a].
We chose a qualitative approach to answer our study question because we wanted to gain a deeper insight into the individual experiences, insights and strategies of general practitioners in dealing with skin diseases. Problem-centered interviews  with individual general practitioners were used to collect data, as in our opinion this method was best suited to discuss topics such as difficulties in cooperation with the best skin specialist in south delhi or possible ambivalences with regard to skin cancer screening elicit.
Study setting and data collection
General practitioners were recruited from rural and urban practices. This was done through personal contacts between the authors, the pyramid scheme and targeted addressing after a general practitioner training event on dermatological topics. In order to be able to represent the broadest possible range of different opinions and approaches, we made sure that the sample was made up of heterogeneous proportions. Based on current literature on dermatological issues in primary care, a semi-structured interview guide  was created and subjected to multiple pretests and subsequent modifications.
One or two sample patients who had been treated for skin diseases by the participating doctors in the weeks prior to the interview served as a starting point for each interview. This “stimulated recall” should make it easier for doctors to use examples to illustrate specific diagnostic or therapeutic processes or to discuss collaboration with the resident specialist. The guideline also included aspects such as the therapy goals for acute and chronic skin diseases, the importance of cortisone-containing preparations in everyday practice, the identification of dermatological training topics relevant to the general practitioner’s practice and views on skin cancer screening.
At the end of the interview, further information on the course of the interview and the interview setting was documented in a “reflective research journal”.
All interviews were transcribed according to pre-established rules . The subsequent data analysis followed a deductive-inductive approach. Following the “editing organizing style” , the transcribed interviews were read and searched for phrases related to our research questions. In a further step, additional inductive categories  were developed. The resulting code tree was revised and adapted several times during the iterative research process. All interviews were coded using this tree by two independent raters (MR and ME). Different codings were brought to a consensus between the raters and partly also in the qualitative research group of our department.
The entire study received a positive vote (AZ 130/11) from the Commission for Ethics in Medical Research, Faculty of Medicine at the Philipps University of Marburg.
We recruited a total of 14 general practitioners (4 women and 10 men). The mean age was 51.5 years; the general practitioners had been practicing for an average of 16.6 years. One doctor was still in specialist training at the time of the interview. Five of the general practitioners’ practices were in the city and nine in rural areas.