Medical Care

Planet Ecology

Some Topics

A Body Divided

A fundamental problem in human cognition is the limited ability of each person to understand an ever increasing body of knowledge. There is an increasing need to develop specialized knowledge and skills that fit with a local group's requirements. In medicine and surgery, specialists are experts in very specific aspects of body function. Hospitals are organized around "systems" such as the circulatory, respiratory, digestive, nervous systems. Subspecialties deal with components of each system. But, each person is a whole system of interacting parts. A whole person entering a medical institution when something goes wrong will discover that they are not a whole any longer. They may discover that even a team of specialists examining their various parts will not understand the whole experience they are having.

For example, atherosclerotic arterial disease is a whole body disease, but tends to be managed by physicians and surgeons as a localized disease. In other words, when the heart arteries are plugged you go to see a cardiologist and then a heart surgeon. When the vessels to the brain are involved, you go to a neurologist and then possibly a neurosurgeon. When the vessels to your leg are obstructed, you go to a peripheral vascular surgeon. When the vessels to your penis are plugged, you go to a urologist and a marital counselor.

Even single organs such as the heart are divided into parts, procedures and pathologies, each with its own specialists. In the good old days you had internists who understood something about how the internal organs interacted. But rather than praising and preserving generalists who still had whole patients in view, generalists were forced into subspecialist or pushed out of the big hospitals.

Veith suggested that a single specialty devoted to noncardiac vascular disease should be developed. He praised a Swedish team who created such an integrated vascular service. According to Veith: “Instead of many specialties competing for the rewards of treating noncardiac vascular lesions, vascular disease would be managed by those with appropriate judgment, skills, and -- most importantly -- commitment to the field. Specialists with skills derived from many different disciplines would work together within a single department or service without allegiance or obligations to a large department of medicine, surgery, or radiology -- as is currently the case in most institutions and most countries.“

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