I guess it points a little bit to how silly it is that Federation medical personnel also crosstrain in other sciences; there's probably quite enough material in all the different alien species out there to keep someone busy for several life times.

Imagine someone dies on your table because you were too busy studying quantum physics instead of Andoran bacteriology.

where is vulkan heart?

If you know quantum physics, you can not only help someone blasted by some exotic particles but also an entire species with liquid crystal blood, a pair of twins that where quantum entangled at in a teleporter accident and the poor bugger that has an implanted time manipulator to slow down a incurable illness.
You can help all of them or learn one more species microbiology.

I think ship doctors should be generalists that look up details about less prevalent species in the ships medical database.

You make a good case.

What's your in-universe explanation why there don't seem to be any specialists at all on Star Trek? I just looked up a website, probably written by AI so I won't link it, but it says on a modern aircraft carrier are staffed almost like a small hospital, with multiple specialties.

I guess technology can chip away at a lot of the need for specialization, especially diagnostics; like I don't bother my GP with any skin stuff, because they can never tell me what it is--there are too many overlapping similarities between conditions for an untrained eye to determine. And being quickly able to determine whether something is a bacteria or a virus would be another huge boon.

But, sadly, if that were the case, it would mean that Star Fleet doctors are actually quite BAD at being doctors, and what they really are is technicians running machines, the same way modern airline pilots could be quite bad at flying planes since most of their interactions are via a computer.

Bashir frequently talks about having mistaken a preganglionic fiber for a postganglionic nerve, but have you ever noticed that he never mentions what species he's talking about? It's like he assumes it's obvious.

And I assume the Klingon hearts are located in the spots where Worf stabbed Gowron, coz Gowron died almost immediately.

naw. Gowron was just a panzy with no honor.

My explanation is that everything is fully automated. the only times the doctor has to do something is when the programmers of the medbay equipment didn't want the liability, or they can't get to medbay. (and in the latter, their job is to schlep portable equipment.)

this is why they always do the same action. Scan. Hypo. glower. "he dead, Jim". Glower. Scan again. "nevermind." Hypo.

I think specialist have to specialize more they do today because almost every field intersects with almost every species. This means they only have enough patients on large stations and planets.

What's your in-universe explanation why there don't seem to be any specialists at all on Star Trek?

Most episodes tend to be on ships, low population planets/stations or planets that have less access to federation technology that ships (where transferring to a ship would be useful). That's why we the audience don't see the many generalists. (Aside from the medical conference that Bashire gets kidnapped from)

Now that I think about it, a human doctor could even be considered a semi-specialist in star treck, while that would be the most general doctor in todays world. I think those would be on ship, but go unnoticed in a TV show.

But, sadly, if that were the case, it would mean that Star Fleet doctors are actually quite BAD at being doctors,

I think the most indicting thing is, that they aren't calling specialists more often, but that would make for worse TV.

what they really are is technicians running machines, the same way modern airline pilots could be quite bad at flying planes since most of their interactions are via a computer.

I think in the star trek universe the humanoid touch is considered valuable, maybe even necessary for everything from science and navigation to engineering and medical. Otherwise they would send out a lot more unmanned crafts and less cruise ships.

I grew up watching TOS on syndication (I think it was after Hogan's Heroes and it was a constant fight with my mother to start eating dinner without me), and I never thought Star Trek hadn't grappled with or anticipated modern technology.

Until AI.

Yes, of course, Trek has self-aware holograms and androids and what not, but it never really addresses why humans retain so much agency when AI could be making better decisions on their behalf.

My options for this are:

1. LLMs are a serious dead end. If they don't get better, their flaws will become more and more obvious, and maybe there is no progress except for in the future, with the madcap antics of scientists like Noonian Singh and the random accident of Deus En Hologram.

2. Things did get better, the the brain rot associated with AI use became immediately apparent to everyone and so, like money, the utilization of artificial intelligence in the future is somehwat different. This could be a culutural decision that occurs off screen. This is the most satisfying solution for me.

3. This is the saddest option: The Bell Riots happened 2 years ago. Star Trek is an alternate future, but only for a real past.