As the inaugural blog posting of the Society for Pediatric Sedation, I felt it only appropriate that we understand the historic significance of this development in modern medicine. Modern medicine continues to evolve and specialism is alive and well in America as suggested and discussed by Sir William Osler in his address to the emerging Pediatric Society in 1892.
If you have not read this address, I would highly recommend taking the time to do so, it can be found at http://mcgovern.library.tmc.edu/data/www/html/people/osler/index.htm . It was published in the Boston Medical and Surgical Journal Vol 126:19, 457-459. I will utilize this blog to highlight some of the remarkable similarities of Sir Willam Osler’s address and the development of this Society for Pediatric Sedation some 120 years later.
Related to specialism, Osler covers the new specialism which seems unique to American medicine in that time, and gives his perspective of the advantages and disadvantages of such specialism.
On specialism, “ The rapid increase of knowledge has made concentration in work a necessity; specialism is here, and here to stay.” He follows that “Better work is done all along the line: a shallow diffuseness has given place to the clearness and definiteness which come from accurate study in a limited field.” One area of specialism highlighted, is the work of the gynecologists. Though referred to as “belly rippers” and in Osler’s words no profession “had been more roundly abused for meddlesome work”, gynecolgists had learned to recognize tubal pregnancies. Osler had begun to see reports of tubal gestations from the gynecologist as opposed to the pathologist in a post-mortem report. Gynecologists were saving lives through specialized study. Also the public was quick to recognize, even in 1892, the advantage of division of labor and expert knowledge of the specialist.
Coming back to 2009, the development of a specialty in pediatric sedation could be seen as the progression of specialism as discussed by Osler. The rapid increase in knowledge, the increase in specialized agents, the accurate study in a limited field, the saving of lives and public demand can all be credited with the development of yet another specialty in medicine. We, as a society, must recognize that the development of this field comes from many disciplines. Poor outcomes and reports of patient deaths have led to a need for specialized focus in this field. We must value the contributions of our colleagues and minimize the labeling of any group as modern day “belly rippers.” Clearly, sedation is emerging much like the early specialties in 1892.
Of course specialism does have it’s disadvantages and these were concerns in Osler’s age as well. The “radical error” was to not recognize that when one specializes on one area that he does not lose sight of the connection to the complex whole of the body. Osler also had great concern of one specializing “without any broad foundation in physiology or pathology, and ignorant of the great processes of disease.” Osler was also concerned that a specialist “who year in and year out, examines eyes, palpates ovaries, or tunnels urethra” may lose touch with the importance of physiology, or may “degenerate into a money making machine.” Another disadvantage recognized early on, was the threat to the general practitioner especially in the larger cities. However, Osler felt strongly that this threat could be diminished by extra training for general practitioners who could treat the common disorders with the skill of a specialist and “have learned to know his limits and be ready to seek further advice.”
From a perspective in 2009, Sir William Osler was a very wise man. Our society would be very wise to understand these same concerns as this field of sedation moves forward. An early advantage of this society is that this field is originating from the work of a broad breath of sub-specialties. These sub-specialties offer a basis in pathology; physiology and a variety of clinical experience that I believe enhance the field of pediatric sedation. However, we must heed the words of Osler and continue this foundation in pathology and physiology as the field evolves. Research, study of best practice, communication and education are key components. We must be careful to adequately train and educate practitioners who practice sedation without a deep foundation in physiology and pathology. And as suggested by Sir Osler, reimbursement must be a focus to enable our practice but we must not allow “money-making” to dictate our practice or policy making.
Along with specialism in the 1890’s, so came the development of sub-specialty societies and Osler highlights the early success of these entities. “These societies stimulate work, promote good fellowship, and aid materially in maintaining the standard of professional scholarship.” Speaking of the fledgling pediatric society, “this body offers to men….opportunity of knowing each other, of discussing subjects of common interest, and through medium of their publications making general the more special details of value in practice.”
So welcome to the Society for Pediatric Sedation and to this blog. This society, formed in 2005, echoes the goals Sir William Osler had for the Pediatric Society in 1892. Our hope is this Society via research, education, training and communication (as in this blog) will continue to improve access to safe sedation for all children. One last irony, Osler was speaking at the 4th annual meeting of the Pediatric Society, May 2, 1892…. The fourth meeting of the Society for Pediatric Sedation will be held June 7-9th, 2009. We hope to see you there.