Turkiye Klinikleri Journal of Medical Ethics-Law and History

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Tıp Uzmanlık Tarihi ve Tıpta Uzmanlaşmadan Aşırı Uzmanlaşmaya
History of Medical Specialization and from Specializating in Medicine to Over Specialization
Aysun YEŞİLTAŞa
aKastamonu Üniversitesi Daday Nafi ve Ümit Çeri Meslek Yüksekokulu, Kastamonu, TÜRKİYE
Turkiye Klinikleri J Med Ethics. 2019;27(1):65-72
doi: 10.5336/mdethic.2018-61377
Article Language: TR
Full Text
ÖZET
 Sanayi Devrimi ile başlayan uzmanlaşma, sağlık alanında yaşanan teknolojik gelişmeler ve tıp eğitimine verilen önemin artması doğrultusunda tıpta uzmanlaşma olarak ortaya çıkmıştır. Hekimler, tıp eğitimi sonrasında uzmanlaşmaya başlamış, bazı organların hatta hastalıkların uzmanlık alanları oluşturulmuştur. Tıpta uzmanlaşmanın bir ileri seviyesi olarak ortaya çıkmaya başlayan tıp alanındaki aşırı uzmanlaşmanın hekim, hasta ve sağlık hizmetleri açısından değerlendirilmesi çalışmanın amacını oluşturmaktadır. Derleme olarak hazırlanan çalışmada; tıp alanındaki uzmanlaşma kavramsal çerçevede açıklanmış, yeni yeni ortaya çıkan tıptaki aşırı uzmanlaşmanın gelişimi değerlendirilmeye çalışılmıştır. Çalışma sonucunda, tıpta aşırı uzmanlaşmanın; hasta değil hastalık vardır düşüncesini ortaya çıkarabileceği, öğretim üyelerinin iş birliğinden uzaklaşabileceği ve konsültasyonların artmasına neden olabileceği öngörülmüştür. Yine tıpta aşırı uzmanlaşmanın gereksiz sevklere, hekimin hastaya bütüncül bakmamasına ve arada kalan hastalara neden olabileceği ifade edilmektedir.

Anahtar Kelimeler: Tıp; uzmanlaşma; hekim; tıp eğitimi; aşırı uzmanlaşma
ABSTRACT
 Specialization, which started with the industrial revolution, emerged as a specialization of medicine in the direction of technological developments in the field of health and an increase in the importance given to medical education. Physicians have started to specialize after medical education and have tried to become experts in some organs or even diseases. It is the purpose of studying the over-specialization of the medical field which is emerging as an advanced level of expertise in the envy of specialists in terms of physician, patient and health services. This review, which is prepared as a compilation, aims to examine the development and effects of over-emphasis on expertise, which is explained in the conceptual framework of medicine. As a result of the study, the over specialization of medicine is predicted that patients are not sick, there are sicknesses, the academic members divergence from the cooperation and increase the consultations. It is also stated that over specialization in medicine may cause unnecessary referrals, the physician not to look at the patient holistically and patients in between.

Keywords: Medicine; specialization; physician; medical education; over specialization
REFERENCES:
  1. Yılmaz N, Erdem R. [An evaluation on the specialization and holistic approach in medicine]. Suleyman Demirel University The Journal of Visionary. 2016;7(16):35-47.
  2. Yoney H, Yavuz DG. Tıpta Uzmanlık Tercihi. Yayın No: 778. İstanbul: Marmara Üniversitesi Yayınları; 2010. p.164.
  3. Terzi C. [Speciality education in medicine as a mentality problem]. Toplum ve Hekim Dergisi. 2001;16(1):46-8.
  4. Adamson JD. Specialization in medicine. Can Med Assoc J. 1927;17(10 Pt 1):1214[PubMed] [PMC]
  5. Ghormley RK. Specialization in medicine: what is orthopaedic surgery? J Bone Joint Surg Am. 1949;31A(3):459-63. [Crossref] [PubMed]
  6. Pelin SŞ. [Consultation concept from the viewpoint of medical evolution in psychiatry]. Klinik Psikiyatri Dergisi. 2000;3:117-25.
  7. Kershaw R. Special Hospitals: Their Origin, Development, and Relationship to Medical Education: Their Economic Aspects and Relative Freedom From Abuse. 1st ed. Manchester Square, W: G. Pulman & Sons Press; 1909. p.72.
  8. Blustein BE. New York Neurologists and the Specialization of American Medicine. Bulletin of the History of Medicine Baltimore: Johns Hopkins University Press; No:2. 1979. p.17083.
  9. Weisz G. The emergence of medical specialization in the nineteenth century. Bull Hist Med. 2003;77(3):536-75. [Crossref] [PubMed]
  10. Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development: the SPICES model. Med Educ. 1984;18(4): 284-97. [Crossref] [PubMed]
  11. Terzi C. [Specialization in medicine and over specialization: focusing on the field of general surgery]. Toplum ve Hekim Dergisi. 2009;24(2):151-8.
  12. Yakıncı C, Yeşilada E. Koruyucu Sağlık Rehberi. 2. Baskı. TEB Ankara: Türk Eczacıları Birliği Eczacılık Akademisi Yayını; 2013. p.766.
  13. Kullmann L. Specialization in medicine. Int J Rehabil Res. 2013;36(1):91-2. [Crossref] [PubMed]
  14. Yalçınoğlu N, Kayı İ, Işık Ş, Aydın T, Zengin Ş, Karabey S. [The views of intern doctors on medical education in Istanbul Faculty of Medicine, Istanbul University]. J Ist Faculty Med. 2012;75(3):41-5.
  15. Resmi Gazete (29.06.1929, Sayı: 1228) 8034 Sayılı Tababet ve İhtisas Vesikaları Hakkında Nizamname; 1929. p.7636.
  16. Öner C. [Evolution of family medicine specialty in legislations]. Türk Aile Hek Derg. 2015;19(4): 165-9. [Crossref]
  17. Resmi Gazete (09.08.1947, Sayı: 6680) 3/6187 Sayılı Tababet Uzmanlık Belgeleri Hakkında Tüzük; 1947. p.12769.
  18. Resmi Gazete (20.01.1956, Sayı: 9212) 6635 Sayılı Tababet İhtisas Nizamnamesi; 1956. p.13417.
  19. Resmi Gazete (17.08.1962, Sayı: 11199) 6/817 Sayılı Tababet Uzmanlık Tüzüğü; 1962. p.8421.
  20. Resmi Gazete (18.4.1973, Sayı: 14511) 7/6229 Sayılı Tababet Uzmanlık Tüzüğü; 1973. p.11.
  21. Resmi Gazete (19.06.2002, Sayı: 4198) 24790 Sayılı Tıpta Uzmanlık Tüzüğü; 2002. p.3615.
  22. Resmi Gazete (03.02.1987, Sayı: 19361) sayılı Tıpta Uzmanlık Eğitimi İçin Öğrenci Seçme Sınavları Hakkındaki Yönetmelik; 1987. p.545.
  23. Gün İ, Öztürk A, Öztürk Y. [Evaluation of the interns of Erciyes University Faculty of Medicine in their medical education and medical examination]. Toplum ve Hekim Dergisi. 2004;19(2):154-8.
  24. Resmi Gazete (18.07.2009, Sayı: 27292) 2009/15153 Sayılı Tıpta ve Diş Hekimliğinde Uzmanlık Eğitimi Yönetmeliği; 2009.
  25. Bazı Kanun ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılmasına Dair Kanun. Kanun Numarası: 6225, Kabul Tarihi: 6.4.2011, Yayımlandığı Resmi Gazete Tarihi: 26.4.2011, Yayımlandığı Resmi Gazete Sayısı: 27916.
  26. Hoff T, Sutcliffe KM, Young JG. The Helthcare Professional Workforce, Understanding Human Capital in a Changing Industry. 1 st ed. New York: Oxford University Press; 2017. p.208.
  27. Oğuz NY. [Physician-patient relationship in clinical practice]. Turkiye Klinikleri J Med Ethics. 1995;3(2):59-65.
  28. Bulut F, Civaner MM. [Modern medicine is losing its humanistic essence: ?Patients no more, but diseases? is the new motto now]. Türkiye Biyoetik Dergisi. 2016;3(2):66-73.
  29. Vatansever K, Durak Hİ. [How should faculty development be organized in medical education: a collection accompanied by learning theories, basic concepts, practices and examples]. Tıp Eğitimi Dünyası Dergisi. 2007;24:2838.
  30. Pelin SŞ, Çalışır HC. [Medical consultation with special reference to the views of 81 doctors in Ataturk chest disease and thoracic surgery center]. Turkiye Klinikleri J Med Ethics. 1998;6(1):14-9.
  31. Arda B, Kutlay N. [Ankara University Medical Faculty Journal (1947-1996)]. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 1997;50(2):61-6.
  32. Nişancı Y, Nazlı N, Özkan M, Özcan M. [Hekimler arasındaki ilişkilerde etik]. Bölüm 3. Türk Kardiyoloji Derneği Etik Kılavuzu. Arch Turk Soc Cardiol. 2009;37 Suppl 3: 15-8.
  33. Çağlayaner H. [Physician, patient, colleagues: referral and consultation]. Türk Aile Hek Derg. 2006;10(1):1-38.
  34. Erdem HH. [The human condition and idea of ?Education for the future? in Edgar Morin]. Felsefe ve Sosyal Bilimler Dergisi. 2012;13:75-88.
  35. Hazine Müsteşarlığı. [Family medicine practice in Turkey]. Politika Analizi Raporu. Ankara: 2011. p.10-5.
  36. Arslanoğlu K. [Basic diseases of medicine: questions and answers]. Arslanoğlu İ, editör. Tıp Bu Değil. İstanbul: İthaki Yayınları; 2012. 1. Baskı p.11-31.
  37. Dizdar Y. [Nutrition and disease: what is the status of sugar?]. İş ve Hayat Dergisi. 2015;2:9-21.
  38. Ertan C, Akgün FS, Yücel N. [Evaluation of patient transfers to the emergency department of a university hospital]. Türkiye Acil Tıp Dergisi. 2010;10(2):65-70.
  39. Colyer S. Subspecialties Hold Back Generalists; 26 / 21 July 2014.
  40. Baskan S. [Turkish medical education on the threshold of the 2000s]. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 1997;50(1):7-25.

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