The Theory of Medical Evolution – Specialization in Medicine the Way Forward

Dr. Ruchira Dhoke

Medical Microbiologist

Specialization-The process of concentrating on becoming an expert in a particular subject or skill.

Adaptation-The action or process of adapting or being adapted.

Evolution-The gradual development of something.


Are you wondering why am I starting my article with a bunch of definitions which you all know verbatim? Well to explain this, the theory of evolution and reformation of the healthcare system in the current world is the amalgamation of all three words and how they are perceived.

Adapt or Die…

Before the 1700s, the life before the era of specialization, all the doctors used to be generalists. It was a rare sight to find an outlier who practiced specialized medicine and if so was frowned upon with suspicion.

Rare species of craftsmen with lack of formal education and training, earning their livelihood by performing singular tasks of delivering babies or extracting tooth were categorized as charlatans and quacks. The so-called “Regular healers” or the mainstream physicians often felt that these non-licensed “specialists” threatened their livelihood.

In his landmark 1859 book, The Origin of Species, Charles Darwin quotes “It is not the strongest species that survive, nor the most intelligent, but the ones most responsive to change. “And more relative to the above quote was the gradual but certain transformation from a generalist to specialist by the mid-1800s.

A German doctor visiting Paris at the time remarked: “Incredible! Each organ now has its own priest…and for some, they even have special clinics…”

Specialists were born….

With the advent of newer tools and technologies like the microscope, stethoscope,ophthalmoscope, laryngoscope etc., it accelerated the pace of change in medical practice where the medical practitioner could use these instruments to diagnose and further unravel the mysteries of the human body. The focus of the doctors shifted to the organ systems bringing about the start of a coalition of various specialities amongst the medical field (1).

Way forward ….

Specialist, an actor in the cinema of multiple health-care systems specifically trained within a narrower field of medicine, is in high demand and will continue to do so.

Reason being an ever-rising complexity in the diseases and disorders of the human body. Disease has always been a normal part of the world and with healthy wildlife and ecosystems we had the defenses to fend off most of them before they could have devastating impacts.

But now the ecosystems have become vulnerable to mutations allowing genetic diversity, the leading cause of which can be identified in climate change, increase in pollution, loss in biodiversity etc. This has led to emergence of new and rare diseases and calls for desirability in seeking a specialist who is more equipped to treat them.

Gone are the days the consultant physician could know everything in medicine. The exponential rise in advances in technology along with increase in knowledge have led to the emergence of specialists, sub-specialists, and super-specialists.

As specialism in medicine progresses, the treatments are getting evolved and the doctors have adapted a more sophisticated way to treat their patients in this complex health care system. Abiding by the trend, hospitals too are slowly evolving as super specialized or multi-speciality centers since they are perceived to be delivering a better quality of treatment.

Specialists are trained to diagnose and treat the more complex and sometimes more nuanced problems in medicine. While not everyone needs to, one can seek a specialist when the primary care physician recommends it for a specific systemic illness or a rare health issue. It is often seen that a specialist works not singularly but as a team as he might often work hand in hand with a surgical specialist for monitoring, evaluation and management of complicated patients.

References:

  1. https://pubmed.ncbi.nlm.nih.gov/14523260/

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