Division

I shall not elaborate on what came out from that Pandora Box. However, the more I think of it, the more I doubt my nostalgia.

For those who had read the article in the Annals, this is what I mean:

Yes, it is gratifying to do the sputum gram stain, examine the urine sediment, and go through the bone marrow smear for my own patient. Nonetheless, I have come to understand medicine, like the human society per se, has evolved to be an incomprehensibly complicated subject, and no one could do everything by himself. There is more than one bacterial stain we could do for a sputum specimen, the reliability of urine microscopy is very much lower if it is done by a doctor who only uses the microscope once a year, and it really needs an expert to determine what additional immunocytochemical studies are necessary after looking at the preliminary Wright-Giemsa stain of the bone marrow.

As a result, the improving technology means that an ordinary clinician could not take care of them all, and we have dedicated microbiologists to take care of the sputum, hematologist to orchestrate that set of bone marrow slides, and some autistic nephrologist to look at the urine. Each of us focus on a tiny part of an elephant while the very clinician who takes care of the patient as a whole could grasp on nothing. (More likely than not he is a sub-specialist of another area and is being a general clinician rather half-heartedly.)

In other words, the way to hell was paved by our own success.

PS. In that case, is there any one who could look at the whole picture ?

Maybe the dogs.

As Geoffrey Vickers said (in The Art of Judgement): Even the dogs may eat of the crumbs which fall from the rich man's table; and in these days, when the rich in knowledge eat such specialized food at such separate tables, only the dogs have a chance of a balanced diet.