Even if physicians wanted to try to learn/practice/apply across different fields, there is also tremendous push-back from other specialists, and anyone who tries is mocked. In retrospect, the cabal trained docs this way so that one could never understand the full spectrum of illness and treatment because the docs are all walled off from each other.
After the first two years of medical school, all the training then becomes uber-specific to whatever field the med student wants to study. Yet another example of keeping us divided. The fault was built into the system. Thoughts?
Medicine is as you have described. There was a great post by a physician in training who gave up due to seeing the problems in the system. I will agree from the viewpoint of a physician forced to take early retirement due to vaccine mandate.
The system has the hyperspecialization noted above partly due to sheer amount of information. Partly due to ability to control who enters the “guild” of each specialty. These multiple ivory towers then enforce a culture of deference to authority that totally destroys critical thinking. The entirety of training is referring to “evidence” without questioning the evidence. Most easily controlled group once all evidence is government and industry funded.
Journals are a crucial weapon in their war against real science.
The whole “replication/reproducibility crisis” shouldn’t ever have been a thing. Psychology in particular is a total sham because of it, and probably other fields too. “the science” is just not trustworthy!
Additionally, the hyper specialization of disciplines creates a parroting of information from other specializations that one Dr may not understand but they repeat as gospel. For example, my pain management Dr repeated every talking point about infection control and he's a neurologist. It's like a diesel mechanic getting advice from a steam powered locomotive engineer. The diesel mechanic will just go along with what the steam locomotive guy says because he knows nothing about trains much less Boyle's law and he has no desire to educate himself either.
Check out Dr. Glaucomflecken. He does these bits about multidisciplinary rivalry. As is true for all humor, what makes it funny is the truth of the joke.
Hyperspecialization falls away in the most rural of areas. Many doctors do stuff outside their given areas when specialists are not available. As a surgeon in metro areas I stick to my field of general surgery and not other specialties because in metro areas practicing outside your scope will result in a lawsuit. Urologists PAY malpractice to do urology procedures. As a Trauma surgeon I can do urology procedures but I'd only do it if no urologists are available and to save a life. So, while there are some truths in what you write, it ain't that cut and dry. One other thing... There are specialists for a reason. Would you want your colon cancer cut out by a surgeon who rarely does that procedure or would you want the guy that does hundreds of those procedures every year?
Here's my experience. Have heart conditions so I was referred to the cardiologist, electrophysiologist, cardiac surgeon, etc. They are all associates in the same practice. Three doctors recommended I have 3 different procedures. So I said to them, knowing how stupid their recommendations were, how about I get the heart transplant now, and the next day you can do the pacemaker and the valve replacement. All ass backward. They just looked at me like.... they were actually considering this. (?)
Yep, this in combination with lawsuit happy legal culture - doctors are afraid to step out of line, and just tow the line of what they’re supposed to say to limit their liability.
Specialists are supposed to be specific to a serious issue you are facing and where they have expertise and experience. The over reliance on specialists and the lack of knowledge of your primary care doctor is a bigger concern.
Do you really need to see a specialist if you have high blood pressure? Maybe if your blood pressure is very high and persists after taking medication or undergoing life style changes.
Now a situation where a primary care doctor will immediately recommend a specialist is if you have a specific concern and are adamant about learning what is causing your issue.
Because of potential lawsuits the primary care doctor will delegate the responsibility to the specialist.
It may seem like your doctor is punting because they are but that is how the system works or kind of works currently.
I personally believe the medical field needs to be re-imagined from the ground up. Or, go back to basics for the primary care doctors so the specialists are not swamped with patients.
I got an advanced degree in a highly specialized biological science field. On the way I quickly realized that I could make the most contributions in the "gap" between my discipline and a related, but also siloed discipline. Neither side acknowledged that I was "one of their own". I acquired an interdisciplinary perspective to solve lots of problems in my career but always remained a professional pariah. At the tail end of my career God put me in a spot to see my most important humanitarian "assignment" to come. Little did I know that that task would eventually end my career because it forced me into yet another discipline, collaborating with engineers. The last contribution took on a life of its own, and all my old original fingerprints have long been deleted as latecomers took credit for seeing the need and creating solutions. Man's plans are not God's plan and I'm ok with that. God thrust me into a spot that had more real world impact than I ever imagined possible, even at the cost of my own career.
Avoiding details, would be too easy to doxx. Thanks for reading my blog.
Tldr: the gap between silos is always the most interesting spot to work.
And soon we can replace a lot of them with AI...