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25, 50 & 75 years ago

R.S.A. Lord. The fragmentation of general surgery. ANZ J. Surg. 1992; 62: 175–80 General surgery is a discipline elusive of definition. Everyone knows what the role of a cardiac or ophthalmic surgeon is but the scope of general surgery differs so much between individuals that the concept of general surgery is almost an abstraction. In other words, general surgery has a definition problem, not least among its principal adherents. It was apparent that no definition existed that was common to a wide spectrum of people. The only factor that all could agree on was that general surgery was a broad-ranging discipline difficult to define. It had been in practice and mostly by default, informally defined by exclusion, and more exclusions had arisen almost yearly. Predicting the future is an uneasy enterprise at best and general surgery offers no easy prognosis. Nevertheless, it seems clear that the process of increasing specialization inevitably means further fragmentation. Some of the difficulties that might arise if ever most surgeons became super-specialists, relate to staffing of emergency rosters, retaining holistic management skills and keeping abreast of developments in areas of general surgical interest such as surgical nutrition and wound healing. The point at which super-specialization becomes unhealthy is arguable but surgeons in every discipline must recognize that major advances will continue to arise and that they will require special facilities and expertise. Intending participants in new fields must acquire and practise new skills and inevitably some will disengage from the parent specialty. The worst threat to the craft of surgery will come when we fail to recognize genuine progress and attempt to inhibit our colleagues from full participation in new ventures. We should look ahead positively and secure the future by ensuring that surgical expertise matches the challenges ahead, rather than wistfully recalling happier days when all of surgical practice was within the compass of a single individual.