| Popis: |
Of late, the proliferation of medical specialisation has proceeded at a pace that has left the general public, and even some medical practitioners, reeling. In his landmark book, Divide and Conquer, George Weisz argues that medical specialisation originates in the explosion of scientific knowledge, and development of special clinics and hospitals, of the nineteenth century. Contrary to Weisz, this thesis argues that specialisation in medical practices has been present since antiquity, and that given supportive social circumstances and multiple knowledge claims, the tendency to proliferation cannot be confined to exclusively modern conditions. At a time when calls to ‘respect the science’ have become insistent, such an argument might seem indecorous; but my experiences as a medical specialist (paediatric surgeon) have inclined me toward a practice-oriented interpretation of the history of specialisation. Further, as a participant in the proliferation of medical specialisation, factors other than scientific knowledge were frequently decisive. Accordingly, particularly in my efforts to come to terms with the Australian experience (to which end I undertook over 100 interviews with a variety of health practitioners to ascertain their pathways to their chosen professions and their views on specialisation), I have focussed on specialisations in action, and the interconnections and contexts of practice, as a way to produce a more balanced and nuanced view of the processes at work. An additional benefit of including the Australian story is that the significance of local factors is brought to the fore, undermining temptations to see developments in Europe, the UK and America as definitive. Further, this thesis discusses drawbacks to proliferation; namely, the tendency to undermine holistic approaches to health care, increased cost to the community, and the inclination to treat because one can rather than one should. The thesis offers some recommendations that might help overcome some of the negative effects of specialisation. |
