Do medical specialties reflect the current clinical needs of patients?

In an editorial opening the 2006 Jan issue of Psychotherapy and Psychosomatics Giovanni A. fava (University of Bologna) criticizes the current subdivision of clinical medicine in subspecialties.

The credibility of clinical medicine has come to an unprecedented crisis, due to the proliferation of connections between physicians and the pharmaceutical industry.

The public seems to be more and more skeptical of clinical medicine, also since corporate actions that have placed profit over public health have become regular news media fare. The question is now whether the growing number of episodes concerned with conflict of interest are the unavoidable drawbacks of a independent and satisfactory way, or are the expression of a clinical medicine devoid of its psychosocial dimension and therefore extremely liable to corporate influences. Is the image of a dehumanized, technological medicine, loaded with conflict of interest and with marketing strategies, the only model we have to offer? Or is there a different model which physicians may refer to? This is the question asked by Dr Fava.

Psychosomatic medicine has recently become a subspecialty recognized by the American Board of Medical specialties. Psychosomatic medicine is by definition, multidisciplinary and extended to all areas of medical care. The traditional boundaries among medical specialties, based mostly on organ systems (e.g., cardiology, endocrinology) appear to be more and more inadequate in dealing with symptoms and problems which cut across organ system subdivisions. Psychosocial factors may operate to facilitate, sustain, or modify the course of disease, even though their relative weight may vary from illness to illness, from one individual to another, and even between two different episodes of the same illness in the same individual.

Psychosomatic medicine calls for interdisciplinary specialists, such as psychoneuroendocrinologists and psycho-oncologists, who may deal more effectively with current challenges of clinical medicine. We need a psychosomatic subspecialty in clinical areas other than psychiatry (internal medicine, gastroenterology, rheumatology, etc..). There is also the need for inter-departmental divisions, for both research and clinical purposes. In the sixties, Hinkle was heading the Division of Human Ecology of the Departments of Medicine and Psychiatry of Cornell University. It is difficult today to envision something which may overcome the artificial boundaries that the game of power has built inn the medical system.

Psychosomatic medicine is the home of interdisciplinary work and of physicians who believe that “ how a person experiences the pathological process, what it means to him, and how this meaning influences his behavior and interaction with others are all integral components of disease viewed as a total human response” (Lipowsky, 1969)

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