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This paper presents detailed information about the medical care available to people with dermatological diseases. One hundred people with acne, psoriasis or eczema who had attended an out-patient clinic between two specified dates were interviewed in their homes using a comprehensive, structured schedule. Interviewees were asked about their satisfaction with the treatment and care they had received and, though 81% felt that it had been worthwhile attending the out-patient clinic, there was evidence of dissatisfaction on several specific points. Procedural and psychological aspects of hospital care are discussed and it is suggested that there is considerable scope for developing more effective communication between medical personnel and patients. Primary care and referral are considered and the role of the general practitioner in relation to those with chronic skin diseases is assessed. Interpersonal communication skills, techniques for maximizing consultation time and an understanding of the evidence on such matters as compliance are areas that could usefully be included more widely in the pre-and post-qualifying training of medical staff. This paper presents evidence about several strands of medical care and suggests positive recommendations for the development of the service.The initial aim of this research was to assess rigorously the handicap of skin disease and these findings have been presented elsewhere (Jowett & Ryan, 1985). A substantial amount of information about medical care was also collected from the 100 patients with acne, eczema or psoriasis who were interviewed in their homes. This paper is concerned with communication between medical staff and patients and the organization of services; it also provides an insight into how patients perceive their doctors. Primary care and referralThe majority of people, particularly those with psoriasis or eczema, felt that their GP did not know very much about their complaint. This was usually couched in terms of the GP's