Ackerman AB. A Philosophy of Practice of surgical Pathology: Dermatopathology as Model. New York: Ardor Scribendi, Ltd., 1999

It has been just over 4 years, at this writing, since Bernie Ackerman died on December 5, 2008, in New York City. On that day, I lectured at the University of Missouri-Columbia, my alma mater, on why I disagreed with the concept of the dysplastic nevus. My lecture was titled: “Dysplastic Nevus: Fact or Fiction?” Bernie was a big influence on what I discussed in that lecture, and it generated a number of questions from the audience, most of whom were residents in pathology who knew little about him or his ideas. As I was driving home to St. Louis, my wife telephoned me about Bernie’s passing. It was a long and quiet drive Ackerman AB. A Philosophy of Practice of surgical Pathology: Dermatopathology as Model. New York: Ardor Scribendi, Ltd., 1999

In the foreword, Bernie lays out the purpose for his book in these words: . . . this book is a treatise about the intrinsic character and quality of the practice of pathology; that is, it is a system of ideas, concepts, and principles formed to enable and motivate the logical and analytical conduct of that practice for the purpose of achieving its raison d'être optimally, to wit, specific, accurate diagnosis. This book . . . endeavors to help students of pathology to inquire into the essence of the practice of pathology and, in the process, to forge a system for practice that is both reflective and effective.
What follows is his treatise.
These 44 chapters are a collection of vignettes about the practice of medicine and pathology, reflections on thought, and insights into a life well lived. If any reader of this review has read this book and knew the man, he or she will grasp immediately that these vignettes are classic Bernie Ackerman. I recall fondly his struggle to find just the right word to turn a phrase in just the right way, and the words in this book are the result of his struggle.
A philosophy of life and a philosophy of practice are difficult to grasp and even more difficult to record in a coherent manner. Bernie begins each chapter by laying out his thesis followed by excerpts from his own articles, or from other writers, with associated commentary.
Because readers of this review probably do not own a copy of this book, I think it should be of benefit to enumerate a list of the chapters with their titles to provide a global sense of it. Afterward, I will concentrate on the issues I found most interesting. and of a method that he described as learning dermatopathology through "historical perspective." I remember well when I first read his articles that employed this method. I was then a pathology resident at the University of Missouri-Columbia and fascinated with surgical pathology. His articles were unusual in that they presented case data but added a layer of cases from history, often including photographs of the original cases, that enriched the experience of reading about the disease in question. Those of you who have read his articles on mycosis fungoides [1] or melanoma in situ [2] cannot have come away unmoved by the experience.
Historical perspective, precision in language, clearly established criteria for diagnosis, and excellent photography were the hallmarks of his work. Chapter 2 of this book visits this approach with a recounting of textbooks written throughout the history of the discipline.
Those of you who have read and studied his books on adnexal proliferations know well that a study of structure and function introduced the weighty subject matter of the sections of proliferations that followed. Chapter 3 details the rudiments of Ackerman's thinking on the subject, and it is accompanied by drawings to aid his conceptual presentation.
In chapter 4, Bernie tackles one's approach to preparing one's mind for perception, conception, and evaluation. How In one sense of the meaning of subjective, however, he is right; the observer perceives the object only with his or her senses, and that process cannot be transferred. It can only be transmitted from one to another in the form of conceptual knowledge. This, then, is the meaning of Bernie's statement that "Still, persons trained to make precise observations can do that with remarkable consistency and repeatability." This statement is true, and it also the reason why the process is Bernie makes a distinction between a clue and a criterion (chapter 13), the latter being more important, as it states a fundamental: "Criteria for diagnosis are the fewest denomi-nators that enable diagnosis to be made." Clues, in contrast, are pointers to the criteria but are not fundamental as such.
He was right about both, and he taught generations of dermatopathologists how to identify them. He proceeds in the chapter by enumerating a few clues (p 221). This approach is absolutely correct and well worth considering.
Ackerman, for practical purposes, introduced dermatopathologists to the concept of pattern analysis for the purpose of an algorithmic approach to diagnosis. Even if he did not originate the method, he made it so accessible and popular that he might as well have originated it. Chapter 14 details some of this methodology beginning with his approach to inflammatory diseases of the skin, which he introduced in his famous "gold book," [4]  there are others. In chapter 17, Ackerman expands this issue of look alikes, but now he emphasizes that most "look alikes" really are not alike at all once one knows the criteria for diagnosis. This is when a differential diagnosis is I will add, this is true especially in medicolegal cases.
When an attorney asks you to "weigh in" on a case, it is very difficult not to have some kind of prejudice just by the nature of the situation at hand. What is the "best special stain" (chapter 27) in dermatopathology? I will leave it to the reader of this review to guess, In short, a mistake is an error, but an error is not always a consequence of carelessness or indifference.
On the contrary, mistakes can be made when great care has been exercised . . . Dr. Ackerman concludes his book with chapters on admitting error, ethics, the joys of individual production and collaboration with others, education, the "business" of medicine versus the practice of the profession of medicine, the master-word of medicine (work), and the magic word of medicine (joy). Finally, Bernie, in a chapter titled "Farewell," lays out his plan for shifting his emphasis in the final phase of his career. He could not have known it, but that phase would last about 8 years, and in that time, he accomplished much of what he stated that he wanted to accomplish. It was a pleasure for me to share in some of that with him.
--• --In the first decade of this century, I had the honor of spending time with Bernie, perhaps in a way that many of his fellows did not. It began with a review of his second addition of Neoplasms with Follicular Differentiation, [5] blossomed into my becoming editor of this section of Dermatopathology Practical and conceptual, and led to a friendship and a collegial relationship that was constant until his death. Reading this book on Bernie's philosophy of practice brought back a flood of memories of the man, his ideas, and why he and they matter still and always will. It brought me back to one of the most challenging times, intellectually and emotionally, of my life.
It is important that each new generation of dermatopathologists discovers A. Bernard Ackerman, MD. Love him or hate him, each one will have to make peace with his positions on ideas in this field. This book, written and published by him at the peak of his faculties, will aid in that desideratum.
As Bernie earned it, he gets the last word: Of all human endeavors, none provides greater possibilities for fulfillment than the profession of medicine, and of all the specialties in medicine, none is more challenging and edifying that pathology. In order to practice medicine, including pathology, wisely and well, one must be guided by an encompassing philosophy. This volume shares such a philosophy about the practice of pathology, one that is rooted in reverence for the discipline and in respect for those who work at it. Let those who read the lines in these pages be as enriched by the experience as was he who composed them.