A good colleague of mine many years ago coined the term “partialist”. Probably plagerised but nevertheless the imagery conjured up by this desription of a specialsist has a particular appeal for family physicians, at least down here at the end of the world. As generalists, family physicians/general practitioners can be said to know a little about everything (in medicine that is) while specialists know a lot about very little. The likes of Barbara Starfield and other researchers have demonstrated the significant benefit to health care in having generalists as the first “port of call” for patients and those of us working in health systems where FPs/GPs are the “gatekeepers” are thankful that at least there is homwbase clinician whom a patient can return as they journey through the world of health care.
The idea of an individual clinician fulfilling that gatekeeping role is changing, moving more to the concept of the practice, not just the doctor, as the “medical home”. Family Health Care Teams and various derivative TLAs (three letter acronyms) used in different countries reflects this thinking and I must admit, it seems to work, given that your practice team operates as a team and not a collection of disparate individuals.
So if generalism is so good, why do doctors pursue partialism? Why is it so valued? Why are specialists paid more? Is it the rarity value of capturing and owning a little niche of knowledge, the power of gnoticism? Is it because a specialists can make more money than a generalist? Perhaps it is the influence of those three humbugs of life: Power, money and fame?
When I was young (such a lovely phrase) and commenced rural GP practice, power, money and fame were for the specialists. GPs/FPs were those who couldn't hack the hospital system, those who rejected the medical hierarchy, those who were not clever enough, didn't work hard enough or were the wrong gender/ethnicity/social class. What is interesting is seeing how general practice has now become a lot more valued in health care in many nations and also seeing how primary health is now leading a lot of health system development.
But whenever you look around primary medical care in your own country, even if it has a great primary care system, you still see GPs and FPs specialising, becoming increasingly limited in their scope of practice, driven into niches of care unpopulated by other medical species, while induldging in self congratulatory reassurance that they are doing the right thing.
Maybe its something in our genes?
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