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Tuesday, November 17, 2009

Specialists vs. Generalists

By Silvia Uribe
Thinking about the way our world operates, it feels that rather than looking for solutions to make our lives not only better, but also easier, sometimes we make things more difficult. We are so invested in being efficient, that we frequently forget to actually address our needs, by making things far more complicated than they need to be. Particularly, I'm referring to how we, little by little, went from being a society of generalists - in almost every possible activity under the sun - and became a world of specialists.
When my parents were growing up, they could visit the doctor -- simply and plainly -- and that doctor was able to determine what their health issue was, its probable origin, and how to cure them or any other person in the family, when they fell sick. This doctor knew and remembered each of his/her patients personally, as he did the medical history, and what medications they responded to. Usually, the cures were quite simple, compared to today's treatments and they were, for the most part, incredibly inexpensive. When worse came to worse, people were sent to a general (again) surgeon, who was able to perform almost any kind of surgery.
When I was born, and while I was growing up, science was incredibly more advanced, and in response, some specializations were common already. There were dentists, eye doctors, cardiologists, OBGYNs, pediatricians, orthopedists, and a few more. But today, the level of specialization is almost ridiculous. I was able to find 21 different specialties, and I'm aware I'm missing many: Internal medicine, Cardiology, Haematology, Gastroenterology, Diabetes, Nutrition, Metabolic diseases, Pneumology, Pneumophysiology, Nephrology, Allergology, Immunology, Endocrinology, Oncology, Rheumatology, Infectious Deseases, Neurology, Psychiatry, Orthopedy, Dermatovenerology (huh?), Physiology, Pathological Anatomy, plus the subdivisions that some of these have. Once I got sent to see the hand specialist. It is as if my hand was a newly built machine, never seen before, and a general orthopedist wasn't given the blueprints.
If we want to look somewhere other than the medical field, we'll find that specializations go across the board. From attorneys to therapists, architects, engineers, designers, mechanics, interpreters, and accountants, it would seem that the different areas of expertise are so narrow that we are not only constraining our own mental and professional sphere, but we're also forcing those who seek services to deal with three or more specialists as opposed to one generalist, and to invest way more time and money that they would otherwise. The poor in our country, and in other countries (certainly in the Third World), don't have any of those resources. Progress, to me, means general advancement, simplification and access, and that's not necessarily what we're getting.
The story is different with consumer technology. In the last fifty years, technology has had enormous advancement; it simplifies our lives and facilitates communication among individuals. Technology also reaches more and more people every day, and thanks to it, awareness about world issues has never been higher. This is a good example of progress that we should try and replicate in other areas.
I wish the same could be said with medicine. I'm not a retrograde, but when money gets in the way of our ability to obtain health services, injustice flourishes. So much specialization could potentially be more harming than helpful, plus we might not be able or have the desire to maintain this pace for much longer. It is definitely not in our collective best interest. If we do, the disparity between the rich and the poor not only in life expectancy, but also in our general quality of life might give way to the worse social injustice ever.
Silvia Uribe is a freelance writer with a Latina perspective.
Cross-Posted at

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