But subject matter, or kinds of things, do not, I hold, constitute a basis for distinguishing
disciplines. Disciplines are distinguished partly for historical reasons and reasons of
administrative convenience . . . and partly because the theories we construct to solve our
problems have a tendency to grow into unified systems. But all this classification and distinction
is a comparatively superficial affair. We are not students of some subject matter
but students of problems. And problems may cut right across the borders of any subject
matter or discipline.
Family medicine could have developed as a division of internal medicine. The
reasons why it did not are as much historical and administrative as they are epistemological.
By the early decades of the twentieth century, internists had ceased to
see children and to do gynecology. At the same time, in many countries, internal
medicine had become functionally differentiated from general practice. By the
1950s, when family medicine began to develop as a discipline, the leadership
of academic internal medicine, with few exceptions, did not see the problems
raised by family medicine as important. Internal medicine at that time was focusing
its attention on the laboratory, rather than on purely clinical observation or
on behavioral and population studies. There is no reason for thinking that this
direction for internal medicine was inappropriate. It did, however, leave a whole
range of problems unattended to, and family medicine was the appropriate discipline
to attend to them.
But subject matter, or kinds of things, do not, I hold, constitute a basis for distinguishing
disciplines. Disciplines are distinguished partly for historical reasons and reasons of
administrative convenience . . . and partly because the theories we construct to solve our
problems have a tendency to grow into unified systems. But all this classification and distinction
is a comparatively superficial affair. We are not students of some subject matter
but students of problems. And problems may cut right across the borders of any subject
matter or discipline.
Family medicine could have developed as a division of internal medicine. The
reasons why it did not are as much historical and administrative as they are epistemological.
By the early decades of the twentieth century, internists had ceased to
see children and to do gynecology. At the same time, in many countries, internal
medicine had become functionally differentiated from general practice. By the
1950s, when family medicine began to develop as a discipline, the leadership
of academic internal medicine, with few exceptions, did not see the problems
raised by family medicine as important. Internal medicine at that time was focusing
its attention on the laboratory, rather than on purely clinical observation or
on behavioral and population studies. There is no reason for thinking that this
direction for internal medicine was inappropriate. It did, however, leave a whole
range of problems unattended to, and family medicine was the appropriate discipline
to attend to them.
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