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    Practice gaps

    "Best available evidence" prevents paralysis

    When it comes to closing practice gaps, says an expert, dermatologists often must weigh their desire for definitive data with the realities of caring for individual patients.

    In other words, says Erik Stratman, M.D., "If you wait for perfect evidence to be available before making a change in your practice, you're never going to change your practice. There are rarely perfect studies," particularly in the field of dermatology. He is chairman and program director of the Department of Dermatology at Marshfield Clinic in Marshfield, Wisconsin.

    Dr. Stratman defines a professional practice gap as the difference between what the professional is doing (current reality) versus what is achievable based on current professional knowledge. In dermatology, he adds, gauging such gaps proves extremely difficult because very few studies measure how the population of dermatologists actually practices. "That's what's so challenging – we don't know what most dermatologists are doing to diagnose and manage disease." To that end, he says, some of the best data on performance in practice come from audience-response questions like those used at the American Academy of Dermatology (AAD) Annual Meeting.

    Furthermore, Dr. Stratman says that in dermatology, "We don't have a lot of guidelines telling us exactly what's the right way to practice. It's a rather empiric field." However, he says that to avoid indecision, "We all must use the best available evidence, which often isn’t perfect. And, we all have to realize, the best evidence today might not be best tomorrow. Think about psoriasis – what we thought about the pathophysiology 10 years ago is completely different than what we think about it today. We must be prepared to act today, but then evolve with new knowledge, testing and therapies."

    NEXT: Psoriasis

    John Jesitus
    John Jesitus is a medical writer based in Westminster, CO.

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