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Article
March 9, 1984

XXI. Medical Practice: Specialization

Author Affiliations

From the Morris Fishbein Center, University of Chicago.

JAMA. 1984;251(10):1333-1338. doi:10.1001/jama.1984.03340340061030
Abstract

Shortly after the middle of the 19th century, specialization in medicine increased greatly. It formed part of the vast expansion of knowledge and the improvement in patient care that characterized the era. However, there also developed many internal strains whose study provides an excellent approach to medical practice and the sociology of medicine.

Central to the story of specialization is the consultant, who could help the general practitioner with a difficult case. In the 17th and 18th centuries, in Great Britain, the physician, who held an MD degree, would act as consultant for the apothecary, who did not have university training.1 In the United States, even though the distinction of physician and apothecary did not obtain, the consultation always had a prominent part in medical practice. By virtue of training and experience the consultant was qualified to give advice. When called in consultation he could unearth new evidence, or

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