Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
In Reply: Opinions about the appropriate extent
of subspecialization in US medicine, on both sides of the issue, are often
vigorously debated. The growth of subspecialization, as I indicated in my
Editorial, is undoubtedly based in the scientific progress of recent decades;
indeed, the extent to which science has reshaped medical practice is one of
the great intellectual and humanistic triumphs of our time.
The issue is not whether we should have subspecialization, but rather
how much. The deeper questions are how to make such decisions and whether
the progress of science by itself will ultimately provide these answers. Science-based
disease management is obviously essential to proper clinical practice, but
particular populations and patients may present additional variables. A more
general approach may be optimal in the identification of newly presenting
disorders and poorly defined symptomatic syndromes. There is also a clear
advantage in continuity of care not only over time, but also spanning the
various health vicissitudes that individuals may experience. As the US population
ages, an increasing proportion of individuals will have diseases in multiple
organ systems that will require simultaneous medical management. There will
be extension of the already evident need for coherence in clinical care and
for someone to make nuanced judgments concerning clinical priorities, including
when to exercise technologic restraint in clinical management.
Barondess JA. Generalist vs Specialist Medical Care—Reply. JAMA. 2000;284(22):2873–2874. doi:10.1001/jama.284.22.2869
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