What is medical generalism?

https://en.wikipedia.org/wiki/Generalist

a physician who provides general health care, as opposed to a medical specialist 

General practitioner, a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients

RCGP medical generalism 

https://www.rcgp.org.uk/policy/rcgp-policy-areas/medical-generalism.aspx

the Commission defines medical generalism as follows

Medical generalism is an approach to the delivery of health care, be it to individuals, families, groups or to communities. Its principles apply wherever and whenever people receive care and advice about their health and well-being. The generalist approach applies equally to individuals and to clinical teams. It is one facet of medical professionalism. Those adopting a generalist approach to the provision of care will need to recognise the limitations of their skills and experience and know when and where to enlist the most appropriate help, support and advice from colleagues – working across inter-professional boundaries and recognising the interdependency of professional skills. 

The underlying principles of generalism are:

Seeing the person as a whole and in the context of their family and wider social environment;  

Being accessible and available to deal with undifferentiated illness and the widest range of patients and conditions;  

Demonstrating concern not only for the needs of the presenting patient, but also for the wider group of patients or population;  

Engaging in effective multi-professional working and co-learning;  

Communicating freely and clearly with patients and professionals across health and social care;  

In the context of general practice, taking continuity of responsibility across many disease episodes and over time; 

and  Also in general practice, co-ordinating care across organisations within and between health and social care.

A similar point was made by Kirstine Knox, chief executive of the Motor Neurone Association, who pointed out that although motor neurone disease was a rare and terminal condition – a GP will on average see only one or two cases in the course of their career – the generalist played a critical role in ensuring that the patient‟s wider needs, including non-clinical social and welfare needs, were met. „For those whose care has been very good, what they will say about their GP is that the GP was there for me from beginning to end and was on the journey with me.’ Kirstine Knox 

The ability to capture the bigger picture of the patient‟s life is not confined to general practitioners, 

‘I am a kidney doctor in my day job, which is traditionally thought of as quite a specialist area, although latterly we have recognised in the kidney world that it is the patients with the kidneys, or the transplants or the dialysis, rather than the kidney per se that is the big issue, and for most people with kidney disease they do not need to darken the door of a kidney specialist. So I think there has been quite a change in the kidney world in the last five or 10 years that recognises more

A biopsychosocial approach, as distinct from biomedical, in that it is accepted that illness may have its causes in, or be aggravated by, psychological or social factors as well as biological. An emerging refinement of this, however, is the biology of biography, which takes a whole-life view of the patient and can trace much illness and disease to childhood and even to pre-natal experience, enhancing perspective and informing clinical management strategy. This seems to offer a more complete approach. 

‘There is so much more evidence now about how biographical events damage biology; they damage genes, they damage physiology. And so one example might be the way that if you have a severely disabled child, your telomeres [the protective zone at the end of each chromosome] are shorter so you are actually ageing faster than your peers.’ Iona Heath, President, Royal College of General Practitioners

The true generalist „looks beyond the surgery door‟, as the King‟s Fund

the onus is on the generalist to differentiate the undifferentiated. The doctor, or sometimes another first-contact professional, must assess the individual‟s condition and arrive at a general diagnosis or arrange further investigation to do so. Central to this is an understanding of probabilities within the population in question

The Commission preferred to look at this role of the generalist as that of 'gate-opener' rather than gatekeeper. The role includes the responsibility to steer the patient to the appropriate gate so that they are seen by the specialist service best placed to meet their needs, thereby avoiding multiple cross-referrals and unnecessary investigations. 

Editor's Choice

Generalism for specialists: a medical reformation

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m157 (Published 16 January 2020)

Cite this as: BMJ 2020;368:m157

Increasingly, patients have two or more conditions at the same time, but clinicians are devoted to one disease, body part, or organ. Training, clinical teams, guidelines, and research are focused on an isolated component. An intellectual shift is required to think of multimorbidity as predictable clusters instead of a random assortment of individual parts. And that sea change is the revival of generalism, even for specialists.

“The pattern of health and disease in our population is changing, and as a profession we must respond.” These are the words of the four UK chief medical officers, of presidents or chairs of the royal colleges of general practitioners, physicians, and surgeons, of leaders of the NHS, GMC, educators, and medical schools (doi:10.1136/bmj.l6964). This is as impressive a list as you will find in any authorship group in The BMJ’s 180 year history, and they present a hard case to argue against. The shift back to generalism should accelerate, they say, and be a greater focus in selection, training, and reward of the future workforce

Views And Reviews Acute Perspective

David Oliver: Celebrating the expert generalist

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3701 (Published 05 July 2016)

Cite this as: BMJ 2016;354:i3701

Medical Schools Council: “doctors prepared to deal with any problem presenting to them, unrestricted by particular body systems and including problems with psychological or social causes as well as physical ones.”

patients have several long term and acute conditions simultaneously. They value personalised continuity and coordination, not piecemeal care by multiple medics. Medical generalism in acute care—the engine room—is key to making general hospitals run and flow.

Generalists are no less expert simply because their skills and value aren’t defined by an organ system or procedure

The exponential growth of evidence and interventions makes it hard to manage specific single conditions as adequately as a specialist. 

Metaphors for generalism 

I used a creative enquiry process to link generalism to randomly generated images 

WHY GENERALISTS BEAT SPECIALISTS | DAVID EPSTEIN

https://www.goodlifeproject.com/podcast/david-epstein/

David Epstein is the author of the New York Times bestseller The Sports Gene and his new blockbuster book, Range, which makes a powerful, science-backed argument about success. Contrary to those who say “find your thing as early as possible, then focus on becoming the best at it,” it turns out those who succeed at the highest levels and stay there longest do not specialize early or become world-class experts in one narrow domain. They actually do the exact opposite. They stay generalists for as long as possible. Early specializers often rise fast, then burn out, leaving those playing a longer, more generalized game to eventually lap them, rise higher and stay successful longer. We dive into the eye-opening research, along with Epstein’s remarkable personal journey in today’s conversation.