Diary of a (secondline) clinicianThere's something of an expectation amongst healthcare professionals that a job is best done by someone who has the most expertise in that area. This makes perfect sense. The increasing specialisation of the medical (and indeed general) workforce aims at least in part to ensure the greatest level of available expertise is performing all tasks that need to be done, while also ensuring appropriate allocation of resources.
If you need your inpatient to start walking before they go home, refer to physio. If an outpatient has presented to your practice with clear lower limb vascular claudication, you're probably going to refer to a radiology service and then a vascular surgeon. A consultant physician who does a walking assessment on the inpatient would be regarded at worst as 'old school' and at best as a 'true generalist' or described as 'embodying the art of the medicine'. Not an egregious infraction on another specialty's area of expertise by any measure. Though their registrars might tut as they regard the long ward round list still to get through. On the other hand, a general practitioner or physician performing their own lower limb ultrasound followed by lower limb angiography or a femoral-popliteal bypass on the outpatient would probably be de-registered. But in the midst of something new that needs to be explained to the public, it seems that all bets are off and many healthcare professionals become experts. Twitter and the popular press are already littered with examples of mainly doctors but other healthcare workers too opining confidently on how COVID-19 will pan out. From people claiming it will be nothing back in January and that we shouldn't worry, to those saying it will all be over by Easter, to yet others who are even now calling for yet more radical changes to society that COVID-19 has 'proven necessary'. It's not clear whether many of these statements were correct and whether they are eventually proven right or wrong is immaterial. What is clear is that many medical commentators have throughout this ordeal made statements, assertions, given advice, and made claims that were in contrast to or opposed those of the experts at the time. The real experts that is. Real experts in this case are the epidemiologists, virologists, public health physicians, respiratory physicians, and others with specific expertise in managing a pandemic caused by a drople(+/- aerosol)-spread virus. We as non-experts, myself included, would do well to remember that we would expect people to listen to our evidence-based recommendations were a situation to arise where our area of specialty/expertise was specifically required. There is a place for calling recommendations into question where they may appear to contradict or not align with evidence. But the impression-based soapbox opinion, often dragged along by the bandwagon, that rises to the surface at times like these is probably something we could do without.
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