farmdoc's blog post number 222

Last week I saw an interesting article in a medical journal. It told me nothing I didn’t know. But I am comforted whenever science confirms an intuition. The article concerned bariatric surgery – which potentially has a high complication rate. It showed that the more bariatric surgery performed in any hospital, the lower that hospital’s complication rate – and vice versa. And the more bariatric surgery a surgeon performed, the lower that surgeon’s complication rate – and vice versa. Previously I’ve read similar articles about other surgery types, and the results are always the same – the more often you do something, the more likely you'll get a good outcome, or at least the less likely you'll get a suboptimal outcome. This is probably the raison d’etre of medical specialisation. A wag half-seriously said a specialist was someone who knew more and more about less and less – until he (or she) knew everything about nothing. Indeed some specialities, e.g. orthopaedic surgery, have splintered into subspecialties, e.g. knee surgery, shoulder surgery. It seems subspecialists’ convergent focus may be outweighed by the disadvantages, because in the last 10-15 years the trend’s been away from subspecialists back through specialists to generalists. It’ll be fascinating to see what happens in the next few years. Me? I’ll stick by the research results and opt for treatment by the specialist with the most experience in the field in question.