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
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