When the way young doctors were trained was reformed nine years ago, voices of dissent were to he heard warning that medics could end up having to choose specialisms too soon, before completing a wide enough range of training.
The outgoing Chief Medical Officer for Scotland, Sir Harry Burns, today echoes those concerns, suggesting that some doctors might be reaching consultant level without the range of experience they once would have had. Sir Harry does not believe two years doing a foundation course is enough before starting down the path towards full specialisation, arguing that medical training is "too prescriptive" and has led to the emergence of "super specialists", when what is needed are more generalists.
He should know. Not only is Sir Harry himself a walking advert for flexibility in medical careers, having first become a respected surgeon before training in public health in response to concerns about how much more slowly patients from poor backgrounds recovered, it has also been his job for nearly a decade to advise the Scottish Government on all aspects of health policy, from health promotion to doctors' training.
A health service that has the capacity to meet the needs of all requires highly expert specialists who can spot the signs of rare conditions alongside more commonplace ones, and have the knowledge to treat them.
On the other hand, the NHS cannot function if it is staffed mainly by doctors who know everything there is to know about the liver or the inner ear, but feel ill-equipped to stray beyond their specialism.
Sir Harry highlights one telling change in the way the service is run, namely that, 40 years ago, doctors from different departments in a hospital would attend A&E to help out if the department was busy; today, emergency medicine consultants are "left to get on with it". Given the well-documented pressures on A&E departments in Scottish hospitals last year, particularly during winter, this is perhaps an opportunity missed. Generalists and "super specialists" are clearly both required in the NHS, but the balance must be right. Sir Harry talks of the need for greater "resilience" in the system. Having more generalist doctors could help. It is to be hoped discussions within the medical profession about responding to this need will bear fruit.
Sir Harry's energy and perspicacity as Chief Medical Officer will be missed. He deserves his share of credit for Scotland's effective handling of major incidents such as the H1N1 flu pandemic in 2009 and the Legionnaires' outbreak of 2012, but has been particularly tireless in seeking to tackle health inequalities. The fact that Scottish Government research shows that healthy life expectancy is declining in the poorest neighbourhoods is not for want of effort on Sir Harry's part.
It will be his successor's job to ensure that health inequality does not slip down the list of government priorities. He or she must also to work with the medical profession to ensure that doctors have the breadth of skills the modern NHS needs.
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