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January 2017

The Need for Ergonomics Education in Dermatology and Dermatologic Surgery: Sit Up Straight, Stand Up Tall, and Carry a Sharp Scalpel

Author Affiliations
  • 1Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 2The Dermatology Institute–Naperville, DuPage Medical Group, Naperville, Illinois
  • 3Web Editor, JAMA Dermatology
  • 4Editor, JAMA Dermatology
JAMA Dermatol. 2017;153(1):13-14. doi:10.1001/jamadermatol.2016.4069

The practices of dermatology and dermatologic surgery require a physician to perform many procedures in the course of a day. These include a host of diagnostic and therapeutic interventions including: biopsies, cryosurgery, injections (ie, steroids, fillers, toxins), as well as longer surgical procedures such as excisions, laser surgery, and Mohs surgery with reconstructive repairs. The number of procedures performed in a given day are arguably some of the highest for any medical specialty. As dermatologists examine patients, there is a tendency to hunch as we lean forward over the patient. Then, the neck is extended to see better, and our posture resembles a turtle sticking its neck out from under the shell. This puts a significant amount of strain on the cervical spine. Sitting at the microscope for hours without a break leads to a “locked-in posture.” Over our years of practice, the risk of musculoskeletal injuries (MSI) increases and may lead to disability that may be career ending. For dermatologic surgeons who spend the majority of their time performing office-based procedures, the risk of MSI is particularly high. An ergonomics study of office-based dermatologic surgery demonstrated that neck, shoulder, and lower back pain were highly prevalent.1 A large survey study of 354 American College of Mohs Surgeon members demonstrated that 90% of respondents reported some form of musculoskeletal symptoms or injures; the 4 most common problem areas reported by respondents were the neck (65%), lower back (63%), shoulders (61%), and upper back (53%).2