Modern is a tricky adjective. The exact moment that an area of medicine can rightly be called “modern” depends on a number of factors. Rudolf Virchow (1821-1902) has been called the father of modern pathology, yet he pooh-poohed Darwinism–the founding principle of evolution, and Pasteur’s germ theory–which is a central pillar of public health initiatives. Sir William Osler (1849-1919) is called the father of modern medicine, yet his was an era that pre-dated antibiotics, chemotherapy, and anti-psychotics.
Most would agree that a field can be regarded as modern when new technologies are used in daily practice. This would mean that we’ve entered the era of modern cardiology with the advent of fully bioresorbable stents; modern surgery with the daily deploying of surgical robots; modern imaging with the combination of positron emission tomography and computed tomography (PET-CT) in a single gantry; and modern pathology with the use of immunohistochemistry to fine-tune diagnostics and digitalization to facilitate education, archiving, image forwarding and logistics.
However, none of these are truly modern specialties but are rather old dogs that have learned new tricks, reflecting the natural progression of medicine. One could argue that I’m playing with semantics, but I feel a modern specialty is one that measures its lifespan in decades rather than millennia. When I started compiling material for this project in 1984, the recurring question was, is this term a “keeper” or not? In the beginning I may not have included as many keepers as I should have, simply because modern specialties have more keepers than classic specialties: I was pretty obsessive about not including material that was the meat and potatoes of the major medical dictionaries. So to distinguish my work from that of others, the operative term was modern.
A modern specialty is characterized by one or more of the following:
• It is focused on a new disease–e.g., AIDS, or one that has increased in frequency–e.g., obesity (bariatrics), geriatrics
• It reflects a major sea change in medicine–e.g., evidence-based practice, managed care, professionalism, right to die movement
• It is an entirely new field–e.g., informatics, transplantation medicine
• It spent a brief period in breeches but rapidly leap-frogged to maturity–e.g., immunology, hospital and critical care, public health, transfusion medicine
I’ve included alternative and complementary medicine and nutrition in this group because both have created a two-fold problem for modern practitioners. Patients are unwilling to admit they’re “treating” themselves, knowing that their doctors are likely to disapprove; at the same time, the “therapy” can cause symptoms that confound the clinical picture and make an accurate diagnosis difficult or impossible.