Few professions are as (0) VULNERABLE to the seductions of hyper-specialisation as academic medicine, and few so the consequences. The modern consultant, trained for upwards of fifteen years to master an ever narrower of anatomy, can diagnose with extraordinary precision within her domain while remaining almost unprepared for what happens at its edges. A patient presenting with symptoms that straddle two specialties is of falling into an interpretive no-man's-land, shuttled between departments each of which insists that the problem lies elsewhere. Junior doctors, caught between pressures to publish within their subspecialty and a conscience still to the older ideal of general competence, increasingly report a peculiar professional loneliness: a sense that no one in the building is quite responsible for the patient as a whole. Proposals to this trend have been circulating for decades, yet medical schools continue to reward the hyper-specialist and to treat the generalist as a kind of regrettable — a figure one might need but whose career trajectory promises little of the prestige accorded to colleagues with narrower expertise. Until the incentives to reflect the clinical realities of an ageing, multimorbid population, the lonely patient and the siloed specialist will continue their parallel unease.