Specialization

November 30, 2021

Legendary doctor Sir William Osler was born in Canada in 1849. He studied medicine in Canada and moved to the US and later, England. He employed his immense intelligence, curiosity, energy and compassion to improve medical care world-wide. He authored textbooks, lectured around the world, wrote volumes of letters, taught at the bedside and practiced medicine. He was one of the “big four” physicians who founded Johns Hopkins Hospital (now John Hopkins University School of Medicine) in Baltimore. His specialty was diagnostics and he is often called the father of Internal Medicine. However, late in his life while continuing his work in England, a grieving mother wrote a moving account of Osler’s compassionate care of her child. I selected the following quote from Harvey Cushing’s two volume biography, The Life of Sir William Osler. “He visited our little Janet twice every day from the middle of October until her death a month later, and these visits she looked forward to with a pathetic eagerness and joy.”  

I introduce this quote as evidence that Osler did not limit his medical care to adults. He also performed minor surgeries, conducted autopsies, examined pathological specimens and saw women with gynecological and obstetrical concerns. Each of these practices is now usually reserved for limited medical specialists. General Internists of today see only adults. Pediatricians only see children. Obstetricians see females. The one exception is Family Practice doctors who see people without such restrictions. Some people view specialization as a modern step in the right direction. I do not agree. Specialization certainly has its place. I want experienced surgeons and surgical subspecialists to do most of the intricate procedures on my body. However, I submit that general medical care is different and for primary care purposes we should not make categorical boundaries as to who is treated.

I will use pediatrics as an example despite some trepidation. After all, who does not love their pediatricians? I genuinely respect my friends who chose to specialize in general pediatrics. I cannot criticize them, but I can and will challenge their specialty. Doctors of all sorts including pediatricians have done a wonderful job of eliminating most of the serious illnesses that took the health and lives of children in the recent past. Antibiotics have almost conquered serious bacterial infections. Viral diseases that once ravaged little people can be mostly eliminated by vaccinations. Type I diabetes is easily survivable because of available insulins. Congenital heart disease can often be successfully treated surgically. Many health problems of childhood persist, but the common problems are easily diagnosed and treated by medical generalists.      

Many of the current epidemic diseases of our time start in childhood and extend into adulthood. Type II Diabetes, tobacco related problems, motor vehicle accidents, drug and alcohol addiction, depression and suicide often surface when people are young. Each one in this group of problems is aggravated or initiated by behavioral choices. Almost all children are members of families. Families have the most powerful impact on human behaviors. I think that doctors who do not say goodbye to girls when they start menstruating or to boys when they start shaving have a better chance of improving outcomes as these problems emerge or progress. As Sir William Osler modeled over 100 years ago, our current primary healthcare workforce should warp toward Family Practice “specialists”.

Sign up for my Newsletter