The Phylogeny of Medicine
William See, MD, Professor of Urology, Chairman, Department of Urology
Words are powerful tools. Contingent upon the context, the media by which they are deployed, the author and no doubt other variables, words can serve as sharp instruments through which to divide, or powerful adhesives which function to bind. The field of medicine exemplifies this concept. For example, it is possible to parse our profession into ever smaller fragments. Academic or community based, part-time or full time, employed or independent, clinician or researcher, office or hospital based, osteopathic or allopathic, physician or non-physician provider are some of the labels applied to health care professionals. If we consider practice focus, it is possible to put an “ever finer” point on the categorization. First, there are clinical fields of practice encompassing generalist or specialist, cognitive or procedural, etc. Within each of these, further specialty distinctions are possible. Adult or pediatric, benign or malignant, male or female, reconstructive or extirpative, minimally or maximally invasive, micro or macro surgeon – the list goes on! While potentially important to our personal identity, what function do these distinctions serve for the field of medicine? Is the academic health care provider with a focus on geriatric female voiding dysfunction any more or less important than the independent, community-based pediatric primary care provider?
I would suggest that these potentially divisive labels are superseded by a series of phylogenetically “higher order” terms. Let’s take urology as an example. Urology is defined as the branch of medicine and physiology concerned with the function and disorders of the urinary system and male reproduction. In the end, no matter the label, physicians trained in the field of urology are all urologists. As urologists, we share a proud history, an expanding knowledge base and a common interest in our future. Urology is the tie that binds, the higher order term to which we remain responsible. At the next level, are we not all health care providers? One could consider this the “transcendent” label to which we are all accountable. Along with the interests of the patient, equitable distribution of health care resources, data-driven decision making, and transparency with respect to outcomes are among our shared interests and obligations.
Medicine in this country is in a state of transition. The challenges facing the medical community threaten to splinter the profession into least common denominator factions, each representing their own interests. In this era of partisan politics and a sharply divided electorate, we must not fall prey to this risk. Within specialties and across the broader landscape of medicine, we will be far better positioned to argue in the interest of our patients and our profession given a unified voice. In the words of Patrick Henry, “Let us not split into factions which must destroy that union upon which our existence hangs.”
This issue of Urology News focuses on pediatric urology, a subspecialty area that represents an important facet of our field. Within The Medical College of Wisconsin Department of Urology, fully one fourth of the faculty focuses their energies on this area. Despite issues that are unique to their profession, the pediatric faculty’s commitment to the Department of Urology and its missions exemplifies what medicine must do to survive into the future. It is the contributions of our entire faculty, including pediatric, oncologic, robotic, reconstructive, and general that have brought us to be recognized by U.S. News & World Report as one of the top 50 hospitals in the country for urology specialty care. As you read the following exciting pages about the field of pediatric urology, and are perhaps prompted to consider your own niche area, please remember that as urologists and health care providers, our common interests far outweigh our parochial concerns.