Medical Super Specialisation is good AND bad for patients!

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  Surgeon volume and early complications after primary total hip arthroplasty | BMJ
  This is an interesting article suggesting that if a surgeon specialises in one type of operation and therefore carries out a large number of them per year, his patients are less likely to suffer complications. 
• In an age when patient outcomes are important, this strengthens the case for further specialisation in different disciplines of surgery. In my specialty, cardiac surgery for example, there are moves now for surgeons just to specialise in surgery of the mitral valve or surgery of the aorta. If I was a patient with mitral valve disease, I know who I would want to operate on my mitral valve . 
• There are however tensions and problems associated with increasing specialisation.
   These tensions were eloquently pointed out decades ago by none other than Kenneth Williams, camp comic extraordinaire from the 19870/80s.
  
• It is said that many of the problems faced today by hospitals, the NHS and healthcare systems in general are due to the fact that in an ageing population, patients suffer not from a single illness but with multiple problems. Specialisation in the specialty of medicine has meant that General Physicians, doctors who had experience in all medical problems and who until 1980s were the commonest type of consultant in a hospital just do not exist anymore. When an old person gets admitted to hospital they are moved from 1 specialist ward to another (or pillar to post) with no one doctor or team taking overall care. In America, where specialisation began much earler than it did in the UK, the problem is now being addressed by the creation of Hospitalists - these essentially are doctors who act as GPs for the patient throughout their journey thru the different specialties in hospital. 
• In the UK, early specialisation in training, a recent trend, is now recognised as not being good for health of the nation. A recent review  entitled the Shape of Training has recognised the problem and has come up with a number of solutions. When I read the report, it seemed that I was being transported back to the future. The solutions certainly vindicate many of the complaints of recent developments in training, not just by whinging old timers like myself but by many junior doctors. 
• So, despite the good outcomes and benefits associated with specialsiation, there are costs when it comes to the common good - a perennial tug of war in healthcare! 
  tags: total hip arhtroplasty surgeon volume cubic spline curves

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