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Problems of site specific cancer specialisation

BMJ 1996; 313 doi: (Published 09 November 1996) Cite this as: BMJ 1996;313:1213
  1. Irving Taylor

    In the fifth century BC Herodotus wrote of the Egyptians, “Medicine with them is distributed in the following way: every physician is for one disease and not for several, and the whole country is full of physicians of the eyes, others of the head, others of the teeth, others of the belly and others of obscure diseases.”

    As we approach the 21st century the topic of subspecialisation in general surgery and its effect on work practice is still debated. There are now recognised (and accepted) subspe-cialties in general surgery, such as vascular surgery, which as a “craft” discipline benefits from concentrated training and regular practice if consistently good results are to be achieved. A surgeon who carries out the occasional repair of an aortic aneurysm (especially if ruptured) without appropriate backup or facilities is unlikely to achieve an outcome as satisfactory as that obtained in a specialised vascular unit.

    There are other subspecialties developing in general surgery where the perceived benefits of “volume” and specialisation may be more difficult to prove, especially when the pathology being treated has an unpredictable prognosis and presents at differing stages of development. I am thinking particularly of the common solid tumours, such as breast cancer and gastrointestinal malignancy.

    Several recent …

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