In recent decades, the landscape of medical care has undergone profound specialization, leading to remarkable advancements in diagnosis and treatment. However, this increasing compartmentalization of healthcare has inadvertently created systemic barriers, particularly for patients grappling with complex, multi-faceted conditions. A groundbreaking study led by Professor Kiyoto Kasai of the University of Tokyo reveals the cascading consequences when specialized medical systems fail to communicate and coordinate effectively. Focusing on chromosome 22q11.2 deletion syndrome, a genetic condition that manifests an array of medical, developmental, and psychiatric challenges, this research uncovers the critical flaws in fragmented care and the transformative potential of integrated, interdisciplinary approaches.
Medical compartmentalization refers to the phenomenon where healthcare providers operate within narrowly defined boundaries of expertise, often neglecting the interconnected nature of patients’ multiple conditions. Professor Kasai and his collaborators used clinical data and patient narratives from the 22q11 deletion syndrome Special Clinic at the University of Tokyo Hospital to construct detailed accounts highlighting the lived realities of such fragmentation. Their seminal paper, appearing in the prestigious journal The Lancet, illustrates how the strict division of specialties can result in outright denial of care, disjointed treatment plans, and diminished quality of life for patients and their families.
One illustrative case in the study centers around a 22-year-old woman, pseudonymously called Cocoro, whose medical journey epitomizes the pitfalls of compartmentalized care. Cocoro’s condition encompasses a surgically corrected tetralogy of Fallot—a complex congenital heart defect—accompanied by mild heart failure, skeletal deformities, autism spectrum disorder, and profound cognitive and sensory difficulties. Despite facing multiple intersecting health challenges, her care was splintered across uncoordinated specialists. This disunion led to her exclusion from various psychiatric and adult care clinics, which cited limitations in managing conditions outside their purview, effectively leaving her without comprehensive support during critical stages of her life.
The failure of the healthcare system to accommodate such multifaceted patients, Kasai argues, stems from the prevailing ethos of medical practice that rewards depth of expertise within narrowly focused disciplines yet often neglects the holistic needs of individuals. This “invisible mismatch,” as Kasai terms it, alienates patients whose symptoms traverse traditional specialty boundaries, leaving them caught between areas of exclusion. Cocoro’s experience vividly illustrates how this approach not only disrupts continuity of care but also exacerbates patients’ vulnerabilities by ignoring the complexity inherent in multi-system disorders.
A significant turning point emerged when Cocoro was eventually treated at a psychiatric department that embraced interdisciplinary collaboration. There, a multidisciplinary team comprising psychiatrists, psychologists, social workers, and medical liaisons conducted a holistic evaluation and orchestrated a coordinated care plan. This shift from fragmented to integrated care supported Cocoro’s re-engagement with her community through workshops tailored for individuals with mental disabilities, fostering social inclusion and peer connections. Moreover, this integrated approach extended to her family, who accessed networks for mutual support, thereby alleviating caregiver strain and enhancing familial resilience.
The study highlights several systemic failings that compound the difficulties faced by patients like Cocoro. Key among these is the absence of a unified care team responsible for overseeing the entirety of her health journey, particularly during critical transitions such as from pediatric to adult services. Additionally, the healthcare system’s narrow focus on patient treatment often neglects the vital role and needs of caregivers, further undermining sustainable care. These challenges underscore an urgent need to reconsider how healthcare is structured and delivered to ensure comprehensive, patient-centered support.
Based on their findings, Kasai and colleagues advocate for sweeping reforms designed to dismantle the barriers entrenched by compartmentalization. First, they emphasize revising medical education curricula to sensitize clinicians to the pitfalls of specialization taken to an extreme and to promote skills for collaborative, multidisciplinary care. Second, they stress the importance of seamless continuity in care during patients’ transitions from childhood to adulthood, a juncture often marked by service fragmentation that disproportionately affects those with complex conditions. Third, they call for systemic policies that eradicate structural impediments within healthcare institutions, ensuring that individuals with co-occurring, long-term health issues are not left stranded within bureaucratic silos.
This research arrives at a critical moment when healthcare systems worldwide grapple with balancing specialization and holistic care. The COVID-19 pandemic has further exposed the vulnerabilities of fragmented care, particularly for individuals with chronic, multifactorial diseases. Kasai’s study provides compelling evidence that integrated care models, which encompass physical, developmental, and psychiatric needs within coordinated frameworks, are essential not only for improved clinical outcomes but also for enhancing patients’ and families’ quality of life.
The repercussions of medical compartmentalization extend beyond individual patient stories—they reflect broader inequities within health systems that prioritize efficiency and expertise over inclusive, patient-centered care. The study’s revelations call on policymakers, educators, and healthcare providers to rethink entrenched paradigms and to foster environments where no patient is marginalized by the complexity of their conditions. Achieving this vision requires embracing interdisciplinarity as a principle rather than an exception and ensuring that organizational practices and funding models support such integration.
Professor Kasai poignantly states that the central lesson from Cocoro’s case and others like it is the imperative to “reconsider vertically segmented medical systems and to promote medical practice and medical education that ensure that no one is left behind.” This message challenges the decades-old norms of specialization, urging a transformation toward healthcare that mirrors the interconnected biological and social realities patients face. As healthcare delivery evolves, integrating emerging technologies with human-centered interdisciplinary care may pave the way for truly equitable, comprehensive treatment.
As efforts to address medical compartmentalization progress, research like this provides a vital blueprint for change. By documenting concrete experiences and outcomes, it lends urgency and specificity to calls for reform, positioning integrated care not as an idealistic ambition but as a clinical and ethical necessity. The study’s publication in The Lancet amplifies its reach, influencing practitioners and decision-makers internationally who seek to reconcile the promise of specialization with the imperatives of compassionate, coordinated care.
Ultimately, the insights gained from this study resonate across disciplines and borders, inviting a fundamental re-examination of how healthcare systems serve their most vulnerable populations. They warn that without such a shift, patients with overlapping medical and psychiatric needs risk continued marginalization, fragmented treatment, and preventable suffering. Conversely, embracing integrated care approaches offers a path toward more effective, humane, and sustainable healthcare for all.
Subject of Research: People
Article Title: Medical Compartmentalisation: A Patient with Chromosome 22q11.2 Deletion Syndrome in Japan
News Publication Date: 15-Nov-2025
Web References: https://doi.org/10.1016/S0140-6736(25)02267-6
References: Kasai, K., Kumakura, Y., Kumagaya, S. Medical Compartmentalisation: A Patient with Chromosome 22q11.2 Deletion Syndrome in Japan. The Lancet, Volume 406, Issue 10,517 (2025). https://doi.org/10.1016/S0140-6736(25)02267-6
Image Credits: Professor Kiyoto Kasai from the International Research Center for Neurointelligence (WPI-IRCN), University of Tokyo, Japan.
Keywords: Health and medicine, Health care, Health disparity, Health equity, Health care costs, Health care delivery, Health care policy, Medical economics, Medical ethics, Hospitals, Patient monitoring, Human health, Public health, Social sciences
