Do we need more generalists or are we each able to take a more generalist approach towards the patient? As an Emergency physician, thats easy for me to say.. as we have to take a more generalist approach to the patient but in the acute setting. Likewise for a Family physician or a GP.
Inevitably, as a specialist (eg: Cardiologist, Urologist..ets...)you are forced to focus on the organ system... during which the 'big picture' is lost.
When treating patients, do we just manage their presenting complains like an algorithm, by following a strict protocol? Or do we manage them according to what is important for the individual? For some individuals, having an answer is important (ie: why did this happen?) while for others, they may want to know how to move on and focus on the future plans. And we have to tailor our approaches when managing these patients.
For example, I met 2 patients in the Emergency room with similar conditions but different agenda over this week.. both had severe COPD (chronic obstructive airway disease). The first family asked me: 'Why does he keep having this breathlessness and keeps coming to hospital; is he not being treated fully before discharge?" The other family asked me "What can they do to manage this situation at home rather than call the ambulance and get admitted to hospital; is there a role for palliative medicine?" Initially, my approach and advice to both families was similar... that breathlessness is a baseline symptom and that they should start engaging palliative services early. However, looking back now, I realise that the first family was probably not ready to accept such advice from me as they still looked upon the doctor as someone who can dramatically reverse their father's COPD; and hence may have even been offended by my advice. They were still in denial of the severity of his illness while the latter had accepted the severity and was willing to move on.
We should have been taught 'health psychology' as a module in medical school training. Medicine is not pure science... it is an art... and many a times, I find myself reflecting on the patients I meet and why the science I was taught in medical school didn't really work while managing them. This is why medicine is so beautiful and interesting.... and we are always learning new things.
Ok.. back to the talk about generalist. In today's defensive medicine climate, the specialist is forced to wholly focus on their organ system. Hence perhaps, we do need a generalist, or a family physician, with whom the patient has developed a close bond with. Someone who not just understands the science of his patient's health but his patient's background, desires, family, hobby, unfinished business, etc... such that the Family Physician/GP can provide a more tailored advice and consult specific for the individual.
But its a 2 way relationship... as generalists are being developed, our Singapore patient population would also need to start trusting their GPs or family physician rather than actively seeking for specialist care in a tertiary centre.
But its a 2 way relationship... as generalists are being developed, our Singapore patient population would also need to start trusting their GPs or family physician rather than actively seeking for specialist care in a tertiary centre.
Here are some articles relating to the discussion of the need for more generalist:
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