When Specialization Promotes Futility

The following scenario is fictitious but not unlike what I encounter in the clinic on a routine basis… Clinician: Have you seen any other providers for your knee/hip/back/shoulder pain? Patient: Yes.  I see an acupuncturist once a week.  He/she sticks needles along the length of my leg and it seems to help.  The chiropractor I see two times a week adjusts my back because it gets out of alignment every few days.  My physician prescribed anti-inflammatory medication and provided a series of injections.  I saw a physical therapist for a few months and we worked on core strengthening.  My personal trainer says I’ll feel better when my fitness improves.  My yoga teacher says I need to be more flexible.

This encounter speaks to the futility of viewing certain phenomena through a very specialized lens (e.g. pharmacology, exercise, spinal manipulation, energy meridians).  Even if each of the aforementioned professions adhered to theoretically and empirically robust practice standards, indeed a generous assumption, their respective political, legal, and educational parameters limit clinical utility. Does puncturing the skin with a needle containing no medication or eliciting a joint cavitation really warrant a distinct profession?  Is therapeutic exercise so complex that it should be studied at the exclusion of other constructs?  How generalizable and relevant are professions that define themselves by particular tools or interventions? Paradoxically, professions that politic to monopolize particular interventions (like acupuncture, spinal manipulation, prescription medication, and injections) render themselves less capable of adequately servicing their customers.  Medical myopia is wasting people’s time and money. Some diseases and procedures, mainly surgical ones, do warrant highly specialized providers.  The orthopedist who limits his/her practice mainly to ACL reconstructions is undoubtedly more adroit at that procedure than a general surgeon.  An ACL tear, however, is a much more concrete diagnosis than can typically be identified in physical medicine and sport. 

Moreover, pinpoint structural diagnoses don’t satisfactorily characterize the practice patterns performance-minded clinicians and coaches encounter in non-contact or atraumatic instances.  How much different is “rotator cuff syndrome” from “biceps tendinopathy” or “scapular dyskinesis” really? Specialization often promotes a kick-the-can mentality among different providers, typically to the detriment of the patient or athlete.  Medicine and coaching need fewer specialists, not more.  That the patient in the above scenario felt compelled to see so many different practitioners speaks to each individual profession’s shortcomings and to the systemic flaws of medicine as a whole.  Complimentary providers should spend more time collaborating to minimize redundancy and diminish the intellectual void created by specialized thinking and identity politics.  Instead, it is more likely that various professions will continue to champion their perceived uniqueness in an attempt to validate their existence.  The pursuit of uniqueness is interfering with the acquisition of knowledge and the application of scientific truth.

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