Defrag., an abbreviation of defragmentation is a new word for me.   Some people may be familiar with it as it relates to defragging the hard drive in their computer to organize the contents of storage devices to free up space.

 

It is the opposite of fragmentation, the process of being broken into fragments, e.g. society broken into a collection of special interest groups.    Fragmentation has been happening for decades in industry and commerce where we see businesses specialize in fewer areas of interest.   In farming and agriculture in recent decades we see people specializing in animal husbandry or tillage or food production, whatever gives them a better standard of living.

 

In Ireland now there is talk of a Farmers Political Party due to dissatisfaction with Fianna Fail and Fine Gael TDs representing their interests.   There are many single-issue political groups aiming to fragment the electorate and break up the established political parties.

 

Fragmentation and specialization is widespread in higher education perhaps in some cases connected to ideas of prestige, authority, power and resources or because of altruistic impulses.   There are levels of fragmentation:  first, second, third, and as these specialists become more isolated the knowledge gap widens between them.

 

I looked at the regulated professions in Ireland and selected a few to examine for specialization.  

1. Architectural Conservation Professionals in Limerick has 15 staff      qualified in 15 different specialties.
2. Solicitors specialize in Corporate Law or Human Rights Law, Employment Law, Criminal Law, Intellectual Property Law, or Clinical Negligence Law.
3. The Medical Profession has highly specialized doctors and surgeons and multitudes of staff working in laboratories. They are experts in particular subjects or skills.   The Cleveland Clinic lists 30 types of doctors and what they do.   The Galway Clinic lists 90 specialists, many of these work at the other hospitals too.   UHG and Galway University Researchers together would have the greatest expertise, which they share with the rest.

 

I am particularly interested in how specialization in the medical profession fragments healthcare delivery for the patient.   Slaintecare’s Mission Statement says The Patient is Paramount and their Implementation Strategy & Action Plan for 2021-2023 is well-meaning.   But increased distance between doctors because of specialization misses the point that human beings are whole bodies, minds and spirits who may suffer complex diseases affecting all their parts.   The Specialist you eventually get an appointment with will focus just on one body part and pay no attention to another region.   If you attend a shoulder specialist he/she will not take a question about your knee.

 

The Action Plan says it will deliver integrated care by bringing teams of people with diverse knowledge together.   I am the beneficiary of the Integrated Care Program for Older Persons (ICPOP) after referral by my GP.   The team consists of a Geriatrician, Nurse, Occupational Therapist and Physiotherapist and they have referred me to a Consultant Orthopaedic Spinal Surgeon at the Galway Clinic.   God knows when I’ll get an appointment with him.   I am thinking that when more people join the team it will be important that all their interactions are beneficial.  

 

I hope that specialization doesn’t mean single-mindedness where a doctor relies too heavily on their own expertise blocking out the team’s valuable advice.

 

The major challenges we now have with energy, climate change, water resources and healthcare for all, including an ageing population, will require the expertise of all the specialists.   They will need to unify, or come together to offer strategies and use their expertise to get us through this part of the 21^st century.

 

Notes:

There used to be people who could do many different types of work that I don’t hear much about today.   I haven’t heard anyone call anyone “A Jack of all trades”, for a long time.   This reference to a would-be universal genius goes back to the 16^th Century.  

 

The description “handyman” goes back to around 1843.   I have heard tradesmen talk of “the curse of the handyman” when some structure failed and they had to fix it.   It may be that handymen are passing themselves as carpenters or plumbers since the apprenticed and trained plumbers and carpenters have gone to Canada or Australia.

 

Back in 1592 writer Robert Greene insulted William Shakespeare by referring to him as an “absolute factotum”.   In 1950s Ireland a General Factotum was the description of an entry level job for an employee who does all kinds of work, perhaps like a PA today.