Specialism - good or bad?
Specialism - good or bad?
Specialists are all around us. Specialism is seen as good. It reduces cognitive load, the reduction of which is perceived by many to be a good thing.
Imagine you were processed for an emergency medical episode. The ambulance is called. The paramedics check your heart. They send you to the hospital as some funny squiggles appear on your ECG. The hospital investigates and then treats you for cardiology issues without any real idea of what’s wrong. But they’re trying to reduce your risk of a heart attack. They promise cardiology tests within a week to try to get to the bottom of things. Is it a good idea to go down a funnel of cardiology in that case? Better to have someone look into this and perhaps it is the right funnel. I don’t know.
But, no notice is taken of your new inclination to lose consciousness and balance momentarily when you bend to get some socks or put on some shoes. No notice is taken of your obstructive sleep apnoea, or your lack of sleep since a close family member died 18 months beforehand.
Imagine also that you have a history of liver issues and non-alcoholic fatty liver disease. You lost weight dramatically and it went away, but slowly the weight crept up again. It dropped again but maybe not enough to say good riddance to fatty liver disease.
But the medical staff at the hospital seem more interested in whether you were vaccinated for covid. I know less than zero about medicine. I know a little about complexity. I would smell ‘groupthink’ in that case and the potential for unsatisfactory outcomes for the patient.
Medical issues are often complex. Relying on single-skill specialist experts is not enough. Even if medical experts get together from skin, liver, cardiology, and various other areas, they might still not spot the issue. In the complex space, cognitive diversity and fresh thinking are needed.
Thoughts about fresh thinking in the medical arena remind me of another person who had advanced cancer in a number of places. His oncologist was trying to treat all his tumors at the same time, but the patient challenged the oncologist. The patient asked which of the tumors was the most dangerous at that point in time. The oncologist explained which one was the most dangerous. The patient asked the oncologist to focus on “zapping” that one first. It was risky but the patient wanted to focus on the next right thing to do, zap the most dangerous tumor. This led to a good outcome for the patient. I am in no position to even suggest such an approach - it could be a road to negative chaos; at the same time I found the fresh thinking interesting.
I heard once of a situation in which a cross-functional team of different medical specialists got together to review patient cases once a month, to improve cognitive diversity. But is it enough for fresh thinking? I’m not sure. I wonder how often nurses were consulted.
In product development, there is a concept of generalizing specialists or specializing generalists. In that space, having some specialists is still seen as useful, e.g. for mentoring and being a guardian of what one specializes in.
I just want to put it out there that I’m not sold on the reduction of cognitive load as always being a good thing. To my mind, excessive focus on the reduction of cognitive load can be a road to avoiding necessary change or learning. Staying in our lane doesn’t always lead to the best outcomes for the customer. In any case, I wonder if the practice of new skills can also reduce cognitive load in the long term. And maybe we can reduce cognitive load by easing off social media and smartphone usage:).
Medicine is designed around specialisms so it’s likely to stay that way. I hope I’ll read more stories about cross-functional groups of specialists reviewing patient cases, stories that include the opinions of nurses. I hope in the next generation we get to see more green shoots of generalizing specialists or fresh thinking in medicine.
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About John Coleman
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