Reflections in Internal Medicine
Generalism in modern subspecializing medicine☆

https://doi.org/10.1016/j.ejim.2017.01.002Get rights and content

Abstract

Introduction

Medicine is currently developing at a breath holding pace. Diseases and medical conditions for which no remedy was available only a few years ago, can now be treated or even completely cured. However, this advancement of medicine comes with increasing complexity in many situations.

Aim and method

This article discusses how we have to adapt our health care organization and our work as physicians to better cope with the new challenges of the enormous advancement of medicine, with a specific focus on internal medicine.

Conclusions

If we want our patients to obtain maximal benefit of the progress in biomedical knowledge and the ensuing improved clinical outcomes in many areas we need to further focus and concentrate complex medical care in a team-based approach. In addition, we need to match increasing subspecialization with an attitude of generalism, both in our clinical work and in our teaching and training programs.

Section snippets

Modern medicine

It was the famous north-American physician William Osler who – impressed by the rapid progress in medical knowledge and insight one century ago – exclaimed “… Never has the outlook for the profession been brighter. Everywhere the physician is better trained and better equipped than he was 25 years ago. Disease is understood more thoroughly, studied more carefully, and treated more skillfully…” [1]. Indeed, in Osler's era hormones and vitamins were discovered, electrocardiography was introduced,

Organization of health care in the 21st century

The very rapid development in molecular genetics and biotechnology, imaging technology, detailed insights in intricate mechanisms such as immunology, host-defense, metabolism, tissue differentiation and cell regulation, and a host of new invasive and non-invasive techniques have resulted in revolutionary changes in medicine in the current era. Diagnostic management, therapeutic options, and preventive strategies are developing at a breath holding pace while not all physicians who practice

Medicine in the 21st century and health care professionals

The question is how we as health care professionals are responding to this biomedical revolution that we are dealing with. In some situations medicine gets increasingly complex, requiring highly specific and multifaceted infrastructure and demanding skills of medical and paramedical professionals. One of the responses of the medical professionals is subspecialization [17]. Subspecialization does not only occur in traditionally “broad” disciplines, such as internal medicine, surgery, or

Solving the paradox: generalism in an ever subspecializing environment

How can we reconcile the ideas that modern medicine needs focus, concentration and as a consequence subspecialization on one hand and that patients need a general rather than a subspecialized approach on the other hand? The solution is actually rather simple. Subspecialization is good but only if it is done by physicians who are willing to think and act also beyond the borders of their specific interest [20]. So when a patient that is treated with steroids for lymphoma develops diabetes, the

References (21)

There are more references available in the full text version of this article.

Cited by (6)

☆

This article is based on a plenary presentation during the European Congress on Internal Medicine, organized by the European Federation of Internal Medicine, Amsterdam, the Netherlands, September 2016.

View full text
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.