What do you do? Tell me about your average day.

I am a dermatopathologist, and you can see my definition of it on the home page, but I will reiterate it here:

Dermatopathology (dermato = skin; pathology = a study of disease):  the medical discipline whose practitioners study and make judgments about the diseases of the skin by means of evaluating the histopathological structure of cutaneous biopsies through a microscope.  The discipline also includes studying skin diseases by means of histochemistry, immunohistochemistry, electron microscopy, and molecular biological techniques when necessary.  Those who practice dermatopathology usually have an MD or DO medical degree but may also have other credentials.

The essence of my work is to establish a diagnosis based on the examination of a biopsy or excision of skin (sometimes staged excisions) so that treatment is effected properly for a patient.  I also write in the field of dermatopathology and teach the discipline to residents and colleagues.  I am also a co-owner of a pathology laboratory, and I have responsibilities in its administration.

Most days begin at 4 or 5 am.  I catch up on my email at home, then arrive in my office usually at 5:30 to 6 am.  On really busy days, I may arrive earlier in my office, at 4 am.

The first part of the day is interpreting follow-up cases.  These are cutaneous (i.e., skin) biopsies or excisions that required special stains, recuts, internal consults, or combinations of these to aid in my ability to establish the diagnosis.  Usually this will take 3 to 4 hours.  Uncommonly, it can take up to 6 hours to make decisions on these follow-up cases.

The second part of the day consists of "new" cases, meaning that these are cases that arrived in the laboratory the day before and were processed to H&E glass slides (hematoxylin & eosin, which is a kind of routine stain to highlight the tissue structure in a standard way).  For the next few hours, triage occurs where I review the slides, check them against the paperwork and the clinical diagnoses, and make decisions.  The decisions fall into one of four possibilities:

  1. I can establish a diagnosis, and do so
  2. I have to order a special stain or recuts or more history (or combinations), which delays the case
  3. I have to consult internally with my colleagues, which delays the case
  4. I have to send the case for external consult to a trusted colleague elsewhere, which delays the case

In my experience, up to 30% of cases will need other things done to them in any given day, thus moving from category 1 into categories 2, 3, or 4.

The third part of my day consists of reviewing case quandaries at the microscope with colleagues.

The last part of my day consists of releasing reports.

In between all of these activities, I sometimes need to photograph cases for conferences.  Most of my writing time and reviewing of literature articles occurs at home in my "off" time.

Usually by 6 -7 pm I head for home.

Most days are 12-13 hour work days, with some exceptions that require 14-16 hours.

I work most weekends also, at least one day or part of a day.