The health minister has stated that specialists should stay within their own areas of specialties.

If the health minister had been in practice long enough, which I seriously doubt, he would have realised that the training in this country has always been for specialists to acquire a primary specialist qualification and subsequently develop a sub-specialty in areas he or she has a special interest in. The fields of sub-specialisation, in this current era of rapid medical progress, are rather fluid.

Which is why you sometimes have a situation of 'overlapping specialising'. A patient who requires facet joint analgesia of the spine can be variously treated by an orthopaedic surgeon, a neurosurgeon, an anesthetist with pain management experience, a radiologist with interventional experience or even a GP, general surgeon or physician who has had the necessary exposure. I am certain the health minister and his advisers are well aware of this.

But the greater question is - who is a sub-specialist and does it hold water to define him as such, at least in this country? Is a six-month attachment with a relevant unit adequate or would the doctor need to undergo a specified fellowship training which can be anything between three months to two years depending on prior experience? Or will a diploma or MSc course do? And even if all this have been carried out, what if the face of medicine changes? Will this training and exposure still be relevant?

Although the Royal Colleges have been in existence for more then a century, the reasons why in the UK they stuck to primary qualifications and ventured only cautiously into accrediting sub-specialty fields (especially in obstetrics, orthopaedics, medicine and paediatrics) was because they realised that rapid medical progress would necessarily mean doctors would need to be flexible instead of being compartmentalised. It is exactly with this foresight that our system was developed along British lines and it is also for this reason that the medical and legal fraternity in the UK has stuck to the Bolam principle.

If all infectious diseases have been eliminated, specialists in this field may have to retrain for the more relevant disaster medicine specialty which caters for pandemics or focus on degenerative illnesses which have today gained greater clinical prevalence. Of greater importance is that physicians in general must work together with microbiologists, pathologists, parasitologists and hematologists. There is no point in reinventing the wheel.

Perhaps the Health Ministry has a lack of personnel in these para-clinical fields which may explain the recent interest in 'infectious disease specialists'. Incidentally, what constitutes an infectious disease specialist and what is his role? The government's infectious disease specialists appear to be lop-sided in focusing on Aids when many physicians in the private sector - faced with a similar situation - would rather work with a hematologist, chest physician or pathologist if faced with a patient with dengue, tuberculosis or typhoid respectively.

Serious infections in the clinical setting are almost always the domain of anesthetists or physicians with a special interest in critical care. The health minister's implicit support of compartmentalisation for sub-specialties is misplaced.

The very nature of specialisation or sub- specialisation - or the lack of it - may mean the doctor possesses, or does not possess, certain areas of competence. But the specialist has primary knowledge in the treatment of patients and his greater responsibility lies with consulting with either his clinical or para-clinical colleagues. This is his ethical responsibility, not wholesale referral which may indeed be quite unethical.

I am afraid the minister's original statement is clearly out of perspective with regards to at least our local healthcare requirements.