[The author responds:]

Letters

CJEM 2006;8(2):77

I thank Drs. Sivilotti and Howes for taking the time to write their thoughtful letter on my Commentary on subspecialization in EM.¹

I feel that their comments support my Commentary — they clearly state that the essence of emergency practice is the skill to "deftly manage a high acuity, high volume shift." They also state that "subspecialized emergency physicians continue to function as generalists."

It is the value of generalist thinking and approach that we must continue to embrace as a specialty. Initially, subspecialists in other fields of medicine also functioned as generalists, but it just became too easy to restrict practice. The emerging literature on the hidden curriculum clearly shows how we devalue generalism in the house of medicine. We can stop the tide from rising!

Doug Sinclair [a.k.a. King Canute]
Chief, Emergency Medicine
IWK Health Centre
Halifax, NS