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dermatology schematic New Medical

schematic cross section of skin

Dermatology is the formal study of the skin, the largest organ in the human body (image, top), which covers two meters of surface area and comprises 15% of the body’s weight, more if we’re tall and overweight, less if not. It is one of the so-called lifestyle specialties of internal medicine. As a dermatologist, one gets the respect that society accords physicians*, a 9 to 5 workday (i.e., no on call schedule), great pay, and minimal malpractice liability (but see below). The cliche about one’s patients in dermatology is as true today as it was when coined years ago: They become regulars in your practice; they never get better, they never get worse, it’s never an emergency and everything responds to steroids.

*True, it’s difficult to take the specialty too seriously in the face of some articles in peer-reviewed dermatology journals: Patient Preference in Dermatologist Attire in the Medical, Surgical, and Wound Care Settings. JAMA Dermatology, 1 June, 2016; DOI: 10.1001/jamadermatol.2016.1186

Such clichés are usually, but not always true. Woe betide the dermatologist who cavalierly passes off a pigmented lesion in a sun-worshiping young adult of mixed race*, convinced that it couldn’t possibly be a melanoma (the bottom image is that of a superficial basal cell carcinoma, which is almost invariably benign). When the patient later learns that yes it was a melanoma, cure by wide local excision is no longer an option once it is thicker than 2 mm and/or ulcerates or metastasizes. 

dermatology New Medical

Skin with basal cell carcinoma

The odds are pretty good that the patient would sue the dermatologist for failure to timely diagnose, a more recent cause of action in medical malpractice circles.

*Individuals with darker skin have a much lower risk of melanoma than those with Celtic and northern European blood lines

As a general rule, however, dermatologists don’t often get in trouble (read, don’t often get sued) and their malpractice insurance premiums and claims frequency reflect that. Whereas surgeons* have 12% to 18% claims (and 3% to 4% actual payouts) per year, dermatologists have 5% claims and a bit over 1% payouts per year, which only slight more than psychiatrists and pediatricians. 

*Neurosurgeons, cardiovascular and thoracic, general, orthopedic, and plastic surgeons