The use of "gatekeepers" may be rational when patients do not know what specialist to see for their condition. Using representative data on outpatient practice in the United States, we tested the hypothesis that when patients believe chev have a skin condition, they have a dermatologic disease. At least 95% of visits for skin symptoms are associated with dermatologic diagnoses. Patients who believe they have skin conditions do have dermatologic diseases and are able to choose the appropriate specialist.