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Partha Kar: Jealousy, rivalry, and disdain—the toxicity of specialty stereotyping

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2080 (Published 31 August 2021) Cite this as: BMJ 2021;374:n2080

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Re: Partha Kar: Jealousy, rivalry, and disdain—the toxicity of specialty stereotyping

Dear Editor

In response to your article, an appropriate quotation which is attributed to Clemenceau, the French statesman, who declared "War is too important to be left to the generals"

That aphorism can be paraphrased to read "liver disease is too important to be left to hepatologists, chest medicine is too important to be left to pulmonologists," and so on. Marshall et al must have come to that conclusion when they published their paper entitled "Constrictive pericarditis: lessons from the past five years experience in the South West Cardiothoracic Centre". In their paper they gave an account of patients in whom the diagnosis of constrictive pericarditis had been missed because they had presented to hepatologists with ascites. As a consequence some had initially been subjected to inappropriate treatment. In others the diagnosis had been missed because they had presented to pulmonologists with pleural effusion. As a consequence some had been subjected to inappropriate pleural biopsy(1).

After a period of time spent in a subspecialty, however prestigious, the superspecialist begins to lose the capacity to "think outside the box". Accordingly, all specialists are flawed, regardless of the position of that specialist in the so-called "pecking" order. This is the inevitable outcome of having to take short cuts in order to keep the production line of that specialty running smoothly. It becomes a treadmill, rather like the assembly line in a motor car factory. I have seen it playing itself out in "real time" when I have attended specialists clinics, either as a patient, or in the company of a close relative.

References
(1) Marshall A., Ring N., Lewis T. Constrictive pericarditis: lessons from the past five years experience in the South West Cardiothoracic Centre. Clinical Medicine 2006;6:592-597

Competing interests: No competing interests

09 September 2021
Oscar M Jolobe
retired geriatrician
British Medical Association
Manchester