Content area
Full Text
The term "tertiary" may be a useful way to categorize a university hospital or specialist centre, but when the term is used to describe the care given to a patient, it is a vacuous construct. When hospital administrators define some patients or medical conditions as outside the remit of tertiary care, doctors come under pressure to think in silos and to abandon their patients.
The most important problem with the idea of "tertiary medical care" is that it is focused on the disease rather than on, as William Osler might say, the person who has the disease. This lapse would be merely laughable if it were a simple oversight; however, it is potentially more serious than that. Not all patients in tertiary centres will fit into a particular eligibility profile, but they nevertheless may have reasons for needing highly knowledgeable and skilled care. The need for care in a tertiary setting may arise not from the rarity or complexity of the condition, but from multimorbidity or a combination of a person's outlook, personality, and personal and family circumstances. Although the condition itself may be relatively straightforward, managing it may require all the knowledge, skill, authority or resources of the subspecialist. Conversely, the fact that a patient is receiving care in a tertiary centre should not restrict...