I am a specialist in premature babies, technically called a neonatologist. In fact I was even more specialized than that, since I focused on nutrition in premature infants. Furthermore, if you can believe it, I became even more specialized, and focused on calcium within the field of nutrition of babies. I think you have an idea of how super specialized I became. You might even call me a “Neonatal Nutrition Calcium” doctor. In fact all my life I have been urging people around me, young people especially, to “focus, focus, focus”, for different life stages, for research goals, or for ultimate life goals.
I was heavily involved in academic research, and knew that if my trainees followed this advice, they would focus on smaller and smaller, more and more refined, and more and more specialized things. This would result theoretically in thorough understanding of the research subject, greater creativity, and more and more research papers! Which is sort of what happened to my own academic life!
So it was with a great deal of trepidation that we started our medical mission in Southwestern China in the 1990s. My super specialization was of near zero practical help, since our mission dealt with relatively rural general medicine, in small villages and communities. There was no need, nor realistic opportunity then for modern premature baby care, the main focus of all my clinical life. In the regions we worked in, I barely saw a modern infant incubator. Let alone a mechanical ventilator! There were no intensive care units, and no support staff with all kinds of sophisticated baby related expertise. I felt literally abandoned and naked.
所以，我们 1990 年代在中国的西南部开始了医疗援助工作时，让我忐忑不安。因为我们项目涉及的需要是乡村小村庄和社区的普通内科，之所以我超级的专业几乎起不到什么实际的作用。当时对我行医生涯的主要焦点——现代的早产儿治疗，没有任何需求或者实践机会。在我们工作的地区基本上见不到一个现代的婴儿保温箱，更别说一个机械呼吸器！没有加护病房，也没有在婴儿护理方面经验丰富的支助工作人员。我真的感到束手无策了。
Essentially I had now gone in the totally opposite direction. I was completely out of my realm, out of my box, and facing medicine that I had nearly forgotten. I remember that even going to the clinic to see “ordinary” pediatric patients was a challenge. I had become so specialized in premature infants, it was decades since I took regular care of patients older than a few months of age. Children in a clinic instead of an incubator! It was a surprising turn of events in my life, a great challenge clearly worth facing!
Actually even before I served in rural China, I already had academic “focusitis” (I made up the word, the disease of “over” focusing). Even when I was practicing medicine among nursery babies, I could even lose perspective. I was supposedly an expert in nutrition, and wrote many books on infant nutrition, but in practice I paid little attention to practical issues of giving nutrition to each baby!
When young doctors and nurses were reporting daily to me about exactly how many cc’s of fluids were given to the babies, or how fluids were given, through tubes via the nose to the stomach or through veins, I confess I was often not totally engaged. Sometimes I distinctly felt my eyes glaze over whenever they mentioned such details. Which sounds terrible of course! My focus and attention was likely on some theoretic nutrition concept or practice, preferably involving calcium! The egg-headed absent minded professor syndrome in academic clinical medicine, basically “focusitis”.
On the mission field, I discovered I was not the only person with this problem. A good friend was an experienced highly expert heart transplant surgeon who was also trying to help in China medical missions. However he was so hyper-specialized that he was of little practical help, since heart transplants were mostly fantasy at the time and place.
Another friend was a high level neurology expert who would be welcomed enthusiastically in any western specialist hospital. But it was difficult to find the right fit for such a sophisticated discipline. All of us, hyper specialized because of training in Western academic medicine, found ourselves like fish out of water!
On the home front, my wife had developed ovarian cancer looked after by an excellent gynecologic oncologist. I knew him well from my medical school and hospital. As gynecologist, he specialized in problems of women, and as oncologist he specialized in cancer, so he was highly qualified and specialized. Impressively, he explained her treatment in thorough academic detail to us.
The operation indeed went superbly well, including meticulous removal of a large number of lymph nodes, and the chemotherapy was excellent. The commonly fatal cancer was eradicated, to our immense relief. He was certainly the super specialized academic colleague I readily identified with.
But this specialization did not cover the simple process of putting in a “port” to infuse the chemotherapy. A port is a device inserted under the skin, in this case in the chest area near the neck veins, so that the nurse could regularly puncture the port, to infuse intravenous chemotherapy fluids into the body. However, it had surprising problems. For example, its removal was a painful mini-operation and the wound became an uncomfortable puckered scar.
In retrospect, we found out this “mini” surgery side effect was common. And the port wasn’t really essential, since a simple option was to puncture a vein once a month, for 6 times. But super specialists are not normally involved with offering choices on these “simple” things, just practical details, I suppose! Another version of my kind of academic “focusitis”. But see the happy ending at https://reggietales.org/scars-english-version/
I’ve often heard of the unfair joke that super specialized ophthalmologists could be called “ left eye ophthalmologist,” or even left eye retinologist (for the left eye retina). Ophthalmologists really are split into so many sub, sub, sub, specialties, with each branch being so very refined and sophisticated.
After we moved to Seattle, I was delighted to visit a super specialized ophthalmologist who only specialized in glaucoma. I had great confidence in her expert care of my glaucoma, and her sophisticated explanation of my condition and treatment. I felt greatly reassured I was in excellent hands, which was true.
However, I complained several times over two years that my eyes were getting blurry, and I could not see the power point projections in church too well. My complaints were essentially glossed over, I suspect because it wasn’t directly related to the glaucoma. One day, fully two years after I had first expressed my concerns, the super specialist said to me, rather
nonchalantly, as if it had just occurred to her, “Oh, why don’t you just get new glasses?”
What a revelation! I went to get my new glasses right away, and lo and behold, my vision was restored. To my relief, I could see the screen projections at church, and the running words on television, all quite clearly. What a simple solution to a vexing problem to me, the “poor patient”. I’m guessing the vexing was overlooked because it was likely “too simple”. All I needed was glasses. Pretty much out of the hyper focused super specialized realm! The ordinary person might be forgiven to think that simple good vision was a critical end point of eye care.
We often hear a common expression that we sometimes “cannot see the forest for the trees,” or get stuck in details and not remember the big picture. A situation that could entangle a subspecialized neonatal clinician-scientist, a subspecialized gynecologic oncology surgeon, or a subspecialized glaucoma ophthalmologist. It’s a particular warning to specialized people like me, since I tend to always urge people to be more focused in life!
To prevent my focusitis making me stuck in minutiae, I often step back periodically to think about the full perspective. As a practical step, I make systematic 5 or 10 year plans, allowing regular pauses and course corrections in my life journey as necessary. Details (even sub, sub specialization ones) are important; just don’t let them take us off track from the key end point (the main point, the vision if you wish).
To belabor the point, I really prefer a crystal clear vision for my final key destination, the ultimate goal of life. I trust you also have a clear vision?