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Specialisation in medicine: a boon or bane?
V.N. MUKUNDARAJAN
The human body is an engineering marvel — a complex interplay of organic functions and systems which sustain the life within. Different systems of medicine adopt varying approaches to the study of the human body, its organs, diseases and their treatment. Branches such as Ayurveda and Homeopathy consider each individual as unique in composition and attempt to treat the person with a disease rather than the disease itself.
Such a holistic approach is lacking in modern medicine which treats the human body as a sum of parts rather as an integrated whole. The approach here is basically symptomatic with the focus being on the diseased part or system.
The study of the functioning of the human body is a dynamic process where knowledge is evolving continuously. Mankind is yet to comprehend the entire mystery of the human body and mind. Many ailments like cancer, Alzheimer’s disease have defied modern science’s efforts to find a cure. Mental and neurological disorders are on the rise. In such a scenario, it is well nigh impossible for a general practitioner of modern medicine to be equipped with the necessary knowledge and skills to treat the multiple disorders and ailments. Specialisation in specific branches of medicine has become unavoidable.
Advantages
With his focused knowledge, the specialist is more qualified to treat particular diseases than a general doctor. He is in a better position to make a correct diagnosis with the help of specific investigative procedures. For instance, disorders of the urinary system are better treated by a urologist or a nephrologist than by a generalist.
Medical research, drug discovery and treatment methods are improving continuously and only a specialist can keep track of these developments which are relevant to his branch.
Disadvantages
The specialist may be an expert in his area of study. As the modern medicine lacks an integrated approach to the treatment of multiple diseases, the specialist sometimes misses the larger picture while concentrating on a particular area of the body. By exclusively concentrating on particular symptoms, he may miss out on the real causes.
For instance, severe mental depression could trigger headaches, lack of sleep, acid reflux and other gastric disorders. By doing a scan of the brain or endoscopy, the neurologist or the gastroenterologist may declare that the patient is normal and prescribe some medicines in the normal course. If severe depression is left untreated, the possibility of the patient attempting suicide is real. This could be averted if the specialist refers the patient to a psychiatrist. But how many doctors do this?
Another area of concern is the lack of efforts to understand the interplay of multiple drugs on a particular patient. Drugs are sometimes prescribed in a routine manner.
Certain specialists, especially cardiologists, paediatricians, gynaecologists, neurologists, etc., are more in demand and the average time spent by them on a patient is around five minutes. Is it possible to examine a patient, patiently listen to his complaint and clarify his doubts in such a short time? The patient is forced to repeat his visits. The specialists tend to rely more on investigative procedures rather trying to understand each patient as a unique person. But is it possible for a doctor to limit the number of patients he can see in a day, especially when the doctor-patient ratio is low in our country?
Solution
The medical curriculum needs to be reviewed with more emphasis on equipping the students to have a holistic view of the human body and its functioning. A sensitive and humane and individualised approach to treatment should be developed. There is a need for building up a cadre of specialised generalists which may seem a contradiction in terms. The idea is to equip the general practitioners with the skills to understand and detect specific symptoms and advise the patient suitably.
It is not the intention of this writer to attempt to malign the medical community which is doing yeoman service to society despite working in tough conditions. The intention is only to highlight some of the problems faced by the public.
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