Comment: The changing work of the dermatologist

At school I really enjoyed woodwork, such that I hoped to become a joiner – an ambition thwarted by my mother, who had other ideas! I have always enjoyed doing things with my hands and, indeed, built a kit car a few years ago. It’s not surprising, therefore, that skin surgery has always been an enjoyable part of my work. I like the visual aspects of working out how to remove the tumour and, more challengingly, how to reconstruct the defect. I like the ‘feel’ of the tissues and get satisfaction in seeing the results. Barry Monk’s article on the changing nature of the work we do as dermatologists is poignant. Many of the boys I shared a bench with at school went on to the highly regarded craft apprenticeships, working as tool makers and so on. I wonder what has happened to them. As the economy was ‘rebalanced’ in the 1980s, much of the manufacturing industry moved abroad and those trades were lost. Dermatology is starting to go through a similar transition. Although teledermatology seemed to be the threat a decade ago, it is now becoming more mainstream and, in limited situations, rather useful. What is more surprising is how the physical treatments are changing.