Primary care doctors: It’s time to celebrate our generalization

1984 was a great year — not just for George Orwell lovers, or for me as I embarked on my medical education. Daley Thompson won his second Olympic gold medal in the decathlon event, and in securing his place in athletics history also broke the world record. Picture the scene afterwards if you can, as journalists jostled to talk to the great man draped in Union flags and his gold medal.

“Daley — well done on your double Olympic success. Are you now going to consider specializing?”

How will you respond next time you are faced with that question? As a general practitioner (GP), I have been asked many times about my lack of specialization — the implication perhaps being that I have failed in my profession. How do I live with the daily thought that, in some circles, I am viewed as a sub-species, a “not quite made it” doctor?

I think we should celebrate our generalization, our ability to see all comers and usually generate some sort of management plan. We often bemoan the lack of a generalist in secondary care and have recently welcomed with open arms the rapid access to a clinic for those patients who just “aren’t really that well” — this has filled the gap of an urgent outpatient appointment which seems to have died a death.  We can’t all specialize, and we certainly don’t all want to, a bit like Tesco really — come to us and we’ll do our best to sort you out, try not to miss anything important and refer on to a proper doctor when needed.

To paraphrase Fletcher in the great Porridge TV comedy, my specialty is “the statement of the bleeding obvious.” By this I mean that our day to day work is a combination of sharing our medical knowledge, common sense, and our own life experiences with patients. All these three can be helpful at certain times and in different situations but I often wonder if my own experiences of life’s tricky situations, and learning from how patients deal with these are the most helpful for me as a doctor, and also for some of my patients.

When dealing with parents struggling with behavioral issues, people grappling with trying to give something up, or suffering from stress in the workplace, it is frequently not my medical knowledge that I draw on. It is very often my own or learned experiences, combined with common sense that can be most helpful to patients.

Of course, the medical knowledge helps — knowing a little bit about lots of things won’t win me a gold medal, but it might just get me on the podium for those patients presenting without a barcode on their forehead.

Richard Cook is a general practitioner in the United Kingdom who blogs at Dr. Moderate.

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    Ha! Great article Dr. Cook!

    • Richard Cook

      Thanks for reading.

  • John T. Bakos

    Many primary care docs feel like second class citizens because they are paid so. Much of western society equates income with prestige and worth. This is a mistake obviously, but it is the way things are. Primary care physicians/extenders will feel more empowered and more worthy if they are reimbursed better!!

    • Richard Cook

      Thanks for taking the time to read the article.I guess we have to look beyond the pay to get our kicks!
      Pay less of an issue in the UK-many other difficulties with the work though.

      • John T. Bakos

        True, but if you have children to put through college, a high college and medical school debt yourself, a difference between 150,000 a year in primary care (if you are lucky) and $350,000 a year as a specialist can be very stressing!

  • Steven Reznick

    Wonderful article and thank you for leading the cheers. Those of us in general internal medicine realize it is a unique specialty that is just not compensated at a level that can attract sufficient numbers of new practitioners here in the USA

    • Richard Cook

      Thanks for your comments.I am not as familiar with the system in the USA of course.Here in the UK pay is not the main problem-there are a host of other issues that are creating a recruitment problem.
      Thank you for reading.

      • ninguem

        Well, spell it out, in another article if necessary.

        I’ve heard UK GP’s are well-paid. What are the problems you face these days? What’s up with the recruitment problem?

        Has the UK tried recruiting USA physicians? I’m not sure what it is; if things got better elsewhere, or worse in the USA, but I’m seeing an increasing number of USA physicians looking at practice opportunities in Canada, Australia, New Zealand, and the reports are usually favorable. I suspect it’s a combination of both…….conditions for physicians improving in other countries, and deteriorating in the USA.

        Why not the UK?

        • Alice Robertson

          Because of the working conditions. The government monitors your keystrokes…you watch patients suffer from lack of meds and referrals. Try visiting there and spending time in a GP’s office. Many more Canadian doctors come here than go up there.

          Surely you know the UK is covered in foreign docs and I don’t know….they just don’t seem up to par in the general sense.

  • drjoekosterich

    Being a generalist is actually harder than being a specialist as you have a much wider array of things to have to think about. The problem is jargon. We should rename “specialists” as “narrowists”.

    • Richard Cook

      Interesting thought! I don’t think there are any easy jobs in medicine…
      Thanks for reading.

      • drjoekosterich

        You are completely correct

    • Suzi Q 38

      As a patient, I would have to agree with this.

  • ninguem

    Dr. Cook, I would appreciate a UK view.

    I miss Dr. Crippen; he had a great blog “NHSblogdoc”. He was a GP in the NHS. He was a strong supporter of the NHS, but was fully aware of its shortcomings. It was nice to see a UK view from the trenches.

    The blog closed with his retirement.

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