The Limited Specialist

Laymen who bitterly complain that they cannot find their way through the maze of multiplying medical specialties and subspecialties can take comfort: the fractionation of medical practice has gone so far that the specialists themselves are confused. The professional men's anger and frustration over their internal divisions came out clearly from 1,084 physicians of all types polled by Medical Economics (circ. 150,000). No less than 91% worried about jurisdictional disputes and admitted uncertainty over the problem of where to draw the line.

Hardest put to defend his territory was the general surgeon--who, ironically, was himself the king of specialists little more than a generation ago. As orthopedists (bone and joint men) spread out from the big medical-college centers, many surgeons find themselves driven back from the body's extremities. As they retreat to the trunk, they find gynecologists, urologists and others staking claims on some particular organ or area. Only half the general surgeons polled still do orthopedic operations; only one in five does urological, plastic or heart-artery procedures.

Among the more limited specialties there are similar complaints of Balkanization. Pathologists, shut off in their laboratories studying specimens from patients they never see, resent the radiologists' monopoly of tracer studies done with radioactive isotopes. Plastic surgeons, whose practice is supposed to be little more than skin-deep, can hardly lift the scalpel without trespassing. Said one: "Every operation in my field crosses other specialties' borderlines." But it works both ways: the plastic men complain that ear-nose-throat specialists are too willing to bob noses.

Pediatricians should be the happiest of specialists, for as they say. "We are suffering from growing pains." Their business is booming, and because they treat the whole child (thus slopping all over the territory of most other specialists), they take on much of the aura of the oldfashioned family doctor. But even they complain: they would like to get their patients away from the obstetrician more promptly after birth, and some want to edge into consultation on the mother's condition before delivery.

Though most specialists agree that something should be done for their own peace of mind and also the patients' benefit, they have few constructive suggestions. More characteristic is the despairing plaint: "Who's to start working up the 'God only knows' diagnosis?" To that, neither confused specialist nor confused patient had an answer.

This file is automatically generated by a robot program, so reader's discretion is required.