‘Excessive subspecialisation in medicine is not sustainable’

Priscilla Lynch

Posted: Friday, October 2, 2020

Prof Marcel Levi MD

Excessive subspecialisation in medicine is not a sustainable model for healthcare, as the COVID-19 pandemic has shown, said Prof Marcel Levi MD, Chief Executive of University College London Hospitals, UK, in his keynote Lecture: ‘Tackling the COVID-19 crisis: professionals in the lead’ at the 38th Congress of the ESCRS.

Prof Levi noted that there was massive redeployment of medical staff during the first wave of the pandemic in many countries, to deal with patients who contracted the virus and to protect other patients and staff, which proved very challenging for many healthcare workers.

“We are now extremely subspecialised. We know very well how to do our jobs but it is very difficult to do someone else’s job,” he said, adding that in older patients presenting with many comorbidities this is a real challenge.

“In the highly specialised medical model of the 21st century there is a different doctor for every disease,” Prof Levi said, acknowledging that while positive in many ways, “hyper specialisation” can lead to the “forgetting that a patient is more than a collection of organs or parts of organs and that there is actually a bigger picture to address”.

“So many people, including myself, believe we need to rethink our model of subspecialisation. Of course we need specialists in the highly advanced medicine of the 21st century, but the need also remains to have a broad base of better understanding of medicine in general, and maybe across more than one speciality/subspecialty, to properly address these implications.”

Prof Levi suggested clinicians should move away from over-focusing on one small area, and aim to instead be “super specialists who are a little more capable of doing a bit more than their highly specialised area.”

He also spoke about the key role of clinicians in leadership and the need for managers and clinicians to work better together, collaboratively, as has happened during the pandemic. “It is not about power, it is about influence.”

Prof Levi said that managers speak a different language which “doctors and nurses do not really understand or want to understand”, but they really should become more involved in leadership.

Summarising his lessons from the pandemic, Prof Levi said “we need to put professionals in the lead, put managers in a supportive role and then we can achieve the most fantastic things much to the benefit of our patients and also to ourselves.”