The knowledge explosion and the internet are part of the forces transforming medicine, a major part. Another is the control that managed care exerts over physicians' activities.The fact that we use the term "managed care" exemplifies the degree to which we are controlled by third parties.(the term itself is an insurance industry term to define the discussion by using language to achieve the interests of particular group)
The more I think about it the clearer it is to me that what physicians and students set out to be a generation ago is not possible. Dr. Thomas H Lee in the March 17, NEJM says is simply "There is simply too much to know". As if The too-much-to-know condition is not enough, there is also the constraint that various managed care entities exerts sometimes leading to the untenable situation where the doctor knows what should be done but finds it cannot be done. Certainly for the generalist, there is too much to know. I think a specialist, a pulmonologist or endocrinologist or urologist might, but a general internist or a family practioner..I think not.