Monday, 11 November 2013

Kenneth Williams and the Future of Surgery

In the 1940s,  general surgeons operated on most body cavities, including the thoracic cavity. During the 1960s, the speciality of cardiothoracic surgery emerged - surgeons operating on 'just' the lungs, the heart and the oesophagus.

The oesophagus 'became' part of the upper GI tract and as upper GI surgery emerged as a specialty, oesophageal surgery was lost to the upper GI surgeons.
As the clamour to increase the resection rate of lung cancers increased, so did the call for pure thoracic surgical training and the appointment of consultant 'Thoracic' surgeons.
The same evolutionary principles, with knobs on,  apply to cardiac surgery -  pure cardiac surgical appointments and more recently a call for cardiac surgeons with an interest in mitral surgery or with an interest in aortic surgery.  The same has been going on in other surgical specialities for years and in medicine for longer!
The process of specialisation and subspecialisation  cannot go on indefinitely for many, some obvious, reasons -  need for 7 day working, cost of healthcare, emerging personalisation of care, and because the way increasingly elderly patients are being looked after is changing rapidly. The fasting expanding specialty (according to the jobs section of the British Medical Journal) is emergency medicine.  Many US institutions have in recent years appointed hospitalists  - hospital based physicians who look after the patient throughout their journey through the different specialities.
Rural surgery has also recently made an appearance on the speciality stage - surgeon based in smaller hospitals doing abit of everything - as in the 'good old days'.
There are probably advantages in the path to specialisation as far as outcomes are concerned. But as Kenneth Williams so wisely suggests, the road is not endless.   A holistic approach to the care of any ill patient is important and what most patients want.