In this rant I will use the term partialist as a derogatory.  It does not refer to subspecialists in general, just those who ignore any problem that does not fit their tunnel vision of their purview.

Back in the day – the 1970s when I was training, most physicians approached patients first with their subspecialty interest, but they still exhibited generalist thinking.  We had internal medicine subspecialists on the wards and they could discuss the variety of internal medicine as well as their area of expertise.  In fairness, we were already seeing the emergence of partialists, those who only will address their subspecialty.

I was talking to a medical student yesterday.  She told me a story about seeing a patient for a routine subspecialty visit.  She diagnosed depression (part of the “12 point” review of systems required for billing) and wanted to address the depression.  The subspecialist clinic had no interest in that problem.

Too often in the hospital I see one subspecialist call for 3 other subspecialty consults. Of course, I declare that what the patient really needs is 1 good doctor.

I do know subspecialists who have not become partialists.  I believe our current payment system encourages this segmentation, because thinking generally does not enhance payment.

But I believe we all have a responsibility to consider the patient rather than the disease – please check out the Osler quotation.  For those students and residents who plan to subspecialize, please remember that no organ system functions independently of the others.  The patient deserves global rather than partial thinking.  Become a subspecialist, but avoid becoming a partialist.