The cobbler should stick to his last?

"Cobbler: stick to your last!"

Allegedly the artist Apelles (C4th BC) said this to a cobbler who had found fault with the shoes in one of his paintings. Apelles corrected the mistake. When the cobbler went on to criticize the shape of the legs, Apelles said "Cobbler, stick to your last!"

I first came across the advice 30 years ago, at the beginning of something written by Professor Hugh Freeman on Psychiatrists and Community Psychiatry. An erudite and generous man, and one of my early mentors, Hugh Freeman was Editor of the British Journal of Psychiatry for 10 years, from 1983. Prior to that, in Salford, UK, he pioneered the provision of the first alternatives to psychiatric inpatient care, with prototype multidisciplinary teams, the forerunners of contemporary Community Mental Health Teams. He saw the value of involving experts from a variety of disciplines and professions in the complex task of meeting the needs of people with mental illness without admitting them to hospital.

In such multidisciplinary work roles can be usefully blurred. After months working in the best multidisciplinary teams as a junior psychiatrist I would often be surprised to realize for the first time that  a particular colleague had trained as a nurse, or as a psychologist - until then we did not distinguish each other according to discipline, but only by name, and perhaps personality.

Often there seems to be much to be gained by not sticking to one’s last - when it’s all hands to the pump, for example. Finding the advice linked to the work of the psychiatrist was thought provoking, and helpful: it is too easy to stray outside an area of expertise, and get into deep water as a consequence.

In psychodermatology I am able to account for some of the basic dermatology, from early training and clinical experience, but my speciality is psychiatry - I am careful not to go too far beyond the shoes: my colleagues are there to deal with the legs!

What do you think? Comments welcome below!

DrB