[Tendency of specialization in medicine]

The evolution of medicine from an applied science to the extension of specialized medical care delivery, has had a bearing on the student's early decision, influenced by a specialist teacher, to chose specialization in a given field. The author gives current explanations of the specialization process in order to conclude that, in Brazil, one of its leading determinants is a policy of the social welfare system that favors the specialist. Other factors cited are the (not always justified) preference of patients--at least of those who can afford it--for physicians who work with sophisticated equipment, the vested interests of the industry that produces or owns that equipment, and the desire of the young physician to escape the stiff competition he would encounter in general practice, while at the same time separating himself from the somewhat negative image of the general clinician who does not keep abreast of developments in medicine. The author examines the question in light of sociological theories of social and technical division of labor, and asserts that the process has led to the atomization of responsibilities among physicians who have become incapable, because of overspecialization, of viewing the patient as a biological, psychological, social and cultural whole.