Bad medicine: specialisation
BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4903 (Published 08 September 2010) Cite this as: BMJ 2010;341:c4903
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Des Spence conveys a very important message from the frontline - the
dangers of excess specialisation to patient care, postgraduate training
and the way resources are spent. We don't listen to him at our own peril.
Thank you Des.
Raman Lakshman
Competing interests: No competing interests
Finally someone has spoken against this race of specialising and
super-specialising ... there are a few moments ( when I look at the shiny
cars of my surgeon and gynaecologist colleagues ) when I regret my
decision to become an Emergency Physician but on most days I am happy.
Happy because I can still look at a patient as a whole and not just a
belly to operate upon, kidneys to dialyse or not to dialyse or just a man
with one heart and three arteries.
What is being said about the third world is especially true. In my country
Pakistan , a residency program is yet to be approved in Emergency Medicine
while thousands of ill-equipped , ill- manned ER's abound in the country
run by junior doctors yet second fellowships are being offered for high
profile sub-specialities which will be accessed by only a handful of the
general public.
A third world country needs dedicated GP's, Trained Emergency Physicians
and a strong Public Health set-up not fancy high flying docs doing tongue
twisting procedures in glass towers !
Competing interests: I am an Emergency Physician.
Generalisation and specialisation in medicine- Friends or Foe
Dear author,
I read your article with keen interest.
With ever expanding medical scientific knowledge and innovation in
technological advancement in clinical management 1 in this challenging era
of European Working Time Directive 2 with significant reduction of junior
doctors' effective training time, super/ sub specialization seems a
logical workable solution. A well planned collaborative network of units
linking together generalists' unit with multi-super speciality centres 3
may be the optimal way to deliver seamless medical care in 21st Century
even in an emerging economic country.
Certainly, role of generalist is pivotal. It should co-exist with its
counter part of ultra specialised medical care and must not be a 'missing
link'.
References:
1. Brolmann H, Vervest H, Heineman MJ. Declining trend in major
gynaecological surgery in The Netherlands during 1991-1998. Is there an
impact on surgical skills and innovative ability? BJOG 2001;108(7): 743-
748
2. European working time directive. Depart of Health Publication at
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Managingyou...
accessed on 11Sept 2010
3. Wan -Lee Lau J. Generalization versus subspecialization in surgery.
Annals of the College of Surgeons of Hong Kong 2001; 5(4):151-155
Competing interests: No competing interests