Before you call the GMC (or the Samaritans), I’ll point out that this is meant to be a day in the life of a dermatologist. To contrast, this is not to convey that this is typical of the day-to-day life of a dermatologist. I’ve always tried to avoid the tried and trodden path – apart from my enduring love of Coco Pops for breakfast. Thus, if you do pursue a career in dermatology it’s quite likely that your working day will look very different to mine.
4am – Wake up
I wake up at a ridiculous hour for a number of reasons. First and foremost is that I don’t like commuting at busy times – why would I want a journey to take double the length of time than it needs to? Secondly, I’m full of beans in the morning and so like to make use of this high-energy state when I can. Thirdly, dermatology is a fairly sedentary career – I gained weight after having switched from ward-based work as a junior doctor to sitting in a clinic room all day. Waking up early gives me some time to do some exercise.
5.30am – Get on the train
Door-to-door my commute is around 90 minutes. I try to take public transport as much as possible. I’m usually armed with a textbook and some Bose noise-cancelling headphones. This time that would otherwise be spent navigating London’s road can otherwise be put to some use. This is usually when I tend to do my best reading and writing.
7am – Walk through the hospital front door
I’m mindful of my energy levels and try not to waste it on issues that don’t require it. I’ll typically glance at my email to establish if there’s anything that needs urgent attention, leaving the less urgent issues for later in the day. The secretaries will have plonked a heap of patient results letters (e.g. biopsy results/blood test reports) and clinic letters in my admin tray. Again, I’ll try and triage what’s urgent and what can be left until later.
I’ll then try and get some learning done – this can include reading through a journal or a textbook. I also sometimes use YouTube tutorials to learn. I’m currently doing a dermatopathology fellowship and have found Jerad Gardner’s channel very helpful to review pathology.
8am – Multidisciplinary team meeting
Dermatologists don’t work in silos – we need the help of pathologists as well as surgical colleagues to get stuff done. We have a weekly multidisciplinary team meeting (MDT) in which we discuss skin cancer cases. This is important since skin cancer can kill people. Therefore, we tend to agree treatment plans with our peers so that we have consensus. This helps protect the clinician from medicolegal liability (e.g. being a nutter) as well as the patient from rogue treatment plans (e.g. being a nutter).
While some dermatologists enjoy doing big surgeries, most of us will refer any tricky stuff along to surgical colleagues (e.g. Plastic or Maxillofacial surgeons). Given that the case has been discussed at the MDT, this ensures that the receiving surgeon knows what they’ve signed up for. The focus of the MDT switches from skin cancer to inflammatory dermatology on a weekly basis. Inflammatory dermatology essentially refers to skin issues that don’t involve skin cancer – this includes common entities such as eczema and psoriasis. Straightforward rashes typically don’t need the help of the MDT. However, I’m sometimes bamboozled by the weird and wonderful. This is where the combined knowledge of senior dermatology colleagues can be helpful – the cumulative experience of seniors who’ve been doing this for decades can help nail a diagnosis in seconds (where I’ve been struggling for months!)
This is part of the beauty of dermatology – the visual nature of the field means that if you’ve seen the rash before, you can easily diagnose it when you come across it again. Think of it as a medical version of Snap.
9am – Clinic
The clinic room is where we spend most of our working day. Most dermatologists do some themed clinics (e.g. paediatric clinic/biologics clinic/vulval clinic) but the bulk of the job is general (inflammatory) dermatology clinics and Cancer Clinics. Hospital trusts typically have a need for dermatologists because of the financial penalties of a cancer breach. NHS Trusts get fined severely if a suspected skin cancer patient has to wait longer than two weeks to be seen within the clinic. Therefore, an increasing proportion of a day in the life of a dermatologist is occupied by skin cancer. Because of this, many other patients with important but non-cancerous skin issues have significant delays to being seen. Clinic templates vary between hospitals and consultants but I tend to see 12 patients during a morning session. I try to dictate my clinic letters as I go along rather than at the end. I tend to run at least 30 minutes late by the end of the clinic.
1230pm – Lunchtime
If there’s nothing demanding my attention (such as a ward round), I tend to go for a walk during lunchtime. This helps clear my mind of the morning’s stresses and helps get my step count up to something respectable. I try and get back for 1.30pm so I can prepare for the afternoon’s sessions. This includes reading the notes, getting hold of relevant kit (e.g. skin scraping tools if a referral letter queries a potential fungal skin infection) and preparing blood forms.
2pm – Minor Surgery
As a general dermatologist, I don’t have a special focus on skin surgery. I do, however, excise plenty of dodgy moles, take punch biopsies of odd rashes and curette crusty lesions for treatment and diagnosis. I try to avoid anything too risky or large. Having previously taken a biopsy directly through paper-thin skin and going into a varicose vein (with blood squirting everywhere), I now try to avoid being a hero. Surgeons are only too happy to be referred the trickier end of skin surgery.
I do 6 surgeries during the afternoon session. In contrast to clinic, I usually run to time doing surgery.
5pm – Admin
By now, my energy is flagging a little. I’ll have a spot of dinner (shout out to Huel), browse the internet for a bit and try to relax for a few minutes. Once suitably numb, I’ll tackle the admin that I’d deferred throughout the day. This works for me – I haven’t a school run to do and I’d rather use my higher energy periods for higher-order thinking. Seeing patients is the most interesting part of my working day. Dealing with large volumes of admin is part and parcel of being a dermatologist – it doesn’t make it any better though.
6.30pm – Skindoc
While many consultants spend their evenings consulting in private clinics, I prefer doing my private work remotely. Using the platform that I designed with my ultra-smart business partner Dr. James Denny, I provide video consultations and review clinical photographs. People are busy and don’t want to have to take time out of the working day to go and visit the doctor. Skindoc helps people see a consultant, get diagnosed and get the medication delivered to their door.
While still in its infancy, I love the work and challenges of running a teledermatology platform.
8.30pm – Get on the train home
I’m usually flagging by now so the books stay in the bag. I tend to listen to some music, deal with DermCoach emails, respond to all those angry folk on WhatsApp and start to wind down.
10pm – Home – wind down
I’ll start to unwind a little, read some fiction, nod at family members and slink off into la-la-land. I’m often accused of using home as little more than a lodge and reading this back, I can understand why.
And there you go…that’s a day in the life of a dermatologist. Again, I should point out that this is not typical but is just how I spend my working life.