A final result of the multiplication of the means of research, and the
increasing difficulty in becoming expert in the use of the many and
delicate instruments they require, is the growth of what we call
specialties in medicine. The best of us learn to use the ophthalmoscope
to look into the eye, to use the laryngoscope for the larynx, and can at
need examine the urine and the blood, but the men must be rare who are
as competent to use each and all of these means as persons who devote
themselves to single branches of our work. Moreover, the element of time
comes in, as well as the element of such constant familiar practice as
makes for one man commonplace and easy what for another, who is more
generally occupied, is uncommon and unfamiliar. The specialist profits
by the fact that his experience becomes enormous and his work advantaged
by its definite limitations. On the other hand, and nowadays especially,
he is too apt to be one who, after brief hospital work of general
character, or without this, takes up, as we say, the eye, ear, throat,
or uterine organs. Unless he has had at some time a larger and more
varied experience, or unless he is a most unusual man, he is prone at
last to lose sight in his practice of the fact that eye, ear, and womb
are parts of a complicated mechanism, and suffer through its general or
local disorders. Hence the too common neglect of constitutional
conditions, to which are often due the apparent maladies of the organs
to which he devotes himself. Moreover, in certain of the organs of
sense, as the eye, are frequently seen the very first signals of spinal
or other maladies, and if, as too often happens, he sees in some such
sign or symptom only the evidence of a local trouble, and neglects to
look or reason beyond it, he may inflict on his patient the gravest
penalties, by depriving him of the chance of early treatment of some
serious disease, involving lifelong, or even fatal, consequences. This
is a criticism on the man and his training, not on the system of
specialties which has become invaluable.
A reasonable desire to seek aid from physicians of usefully limited
values is another test of the good family physician. I know of men who
are in the habit of saying that they dislike consultations and get
little good from them. As compared to those who too commonly subject
people to the expense of fresh advisers, they are the more dangerous
class. Apt enough in cases of acute disease to bring into the case some
one to share responsibilities which seem grave because near at hand,
they continue to treat chronic cases they do not understand, because
there is no crisis of pain, disability, or danger to bring them to
reason.
Public-domain text, read in full here on John Shaqi.
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