Why Subspecialty Medicine?

History of specialty medicine

  • Since the 1700s, family physicians have been an integral part of the community, caring for families. They are there for births, illnesses, family problems, and deaths. They are a resource for knowledge and support. Beginning in the early 1900s, medical knowledge began to expand rapidly. Scientists and physicians began to push the frontiers in determining the causes of illnesses and in developing treatments for them.

    As medical knowledge grew, it became apparent that one physician could not remain knowledgeable in all areas of medicine. At this important crossroads, physicians realized that they needed to narrow their focus within medicine to better understand the growing body of information. To better serve their patients, they developed expertise about newly discovered diseases and treatments in their areas of interest. Thus, physicians became specialists.

    The specialties of medicine -- surgery, obstetrics, radiology, anesthesiology and internal medicine -- developed and rapidly advanced. The tremendous progress made during the first part of the 20th century underscored the need of specialists within medicine to further promote the discovery and treatment of diseases.

Beginnings of subspecialty medicine

  • During the second half of the 20th century, research in medicine further expanded because of the electronic and scientific innovations. New information about diseases and treatments necessitated the further specialization of physicians. Thus began the era of subspecialty medicine.

    Neurologists became subspecialized in areas such as stroke, seizures, and movement disorders. Radiologists subspecialized in pediatrics, neuroradiology, neurointerventional radiology, general radiology, ultrasound, interventional radiology, musculoskeletal radiology, body imaging, and nuclear medicine.

The team approach

  • Subspecialization has allowed physicians to focus their abilities and learn more about the causes and treatment of specific diseases. Further specialization has resulted in the team approach in which a group of subspecialists coordinate their efforts to address a patient's needs.

    The treatment of neurological diseases is an excellent example of how the team approach benefits the patient. For example, a patient who has a seizure is evaluated by a neurologist (often a subspecialist in seizures) who mainly deals with the diagnosis and medical treatment of epilepsy. The patient might undergo an initial diagnostic test called an electroencephalogram, which is performed to look at the electrical wave patterns in the brain. The patient is then referred to a neuroradiologist for a dedicated magnetic resonance imaging (MRI) examination. The neuroradiologist examines the MRI, looking for the source of the seizure. If a source is found, a neurosurgeon specializing in seizure surgery examines the patient to determine if surgery is appropriate. This team approach allows the patient to benefit from the expertise and experience of each of the team members.

    Another example of how the team approach improves care is in patients who have a stroke. Usually, a patient who is having a stroke is brought to an emergency department (ED) where the ED physician first recognizes the acute neurological problem. He or she notifies the neurologist, who becomes the captain of the team. The neurologist examines the patient and asks a neuroradiologist to perform a computed tomographic (CT) or MRI study to determine if the brain is damaged, and if it is, to ascertain if the damage is reversible. If the damage is potentially reversible, a neurointerventionalist (a neuroradiologist who uses small catheters to treat problems in the brain) and the neurologist decide on the best way to treat the stroke. Typically, the cause is a blood clot that blocks blood flow to the brain. The neurologist and/or neurointerventionalist treat this clot by administering a drug to help break it up. Before this procedure is performed, one of the team members discusses the likelihood of its success with the patient and his or her family.

    These two examples demonstrate the importance of the neuroradiologist in the team approach to treating complex neurological problems. As medical discoveries continue, new diagnoses and treatments for known neurological problems will become available, and the role of the neuroradiologist, as well as other members of the treatment team, will become increasingly important.