Over the last few decades, medicine has become more and more targeted. We now have not only the “ologists” like cardiologists, endocrinologists, and rheumatologists, but also subspecialists. Forget orthopedic surgeons, you now have specialists in hips, fingers, and feet.
This tendency has been due to a number of driving factors, most notably perhaps a desire for evidence-based medicine, and perhaps a sprinkling of prestige. Friends who have recently been through medical school and residency have told me the neurology residents don’t think much of the family practice residents, as an example.
This system has worked to a certain extent, especially for acute issues. Why wouldn’t you prefer a finger specialist over a general orthopedic surgeon if you lacerate your finger?
But what happens to this picture when we look at this problem through the lens of the modern chronic disease epidemics? What about when the diseases are multi-systemic? And what if the root cause of the disease is in one part of the body, but the symptoms end up manifesting in another?
This comes at a crucial time when fewer and fewer doctors are choosing family or general practice, internal medicine, or primary care. Furthermore, in many systems, those frontline doctors are being stretched thinner than ever, both financially and in terms of time allotted to spend with patients.
More than ever, we need physicians who understand how different systems interact with each other. We need doctors who know enough about, for example, how diet, exercise, and inflammation are connected. Better still, we need those who are curious to explore new ideas and possibilities, such as the microbiome or the gut-brain connection.
This in mind, perhaps it is time for the era of the “super-generalist.” At the recent Evolution of Medicine Summit, Dr. Rangan Chatterjee, a noted TV doctor and GP from the U.K., spoke of his journey from nephrology to primary care to super-generalist. His was by no means a typical journey, but he felt compelled to do this having been on the front line of medicine and feeling helpless to really help his patients.
He said, “What we’ve forgotten about is that good quality general practice is essential to any healthcare system in the world, both for the patient outcomes and cost-effectiveness…the powers that be are always biased toward allocating more resources to secondary care, but for the problems we’re seeing now, the chronic lifestyle problems, you need the generalist.”
The literature emerging on prevention is robust. Increasingly we’re seeing how much sense it makes for, say, a cardiologist to talk to a patient about diet (given the link between lifestyles and heart disease) or an endocrinologist to suggest ways to prevent inflammation (which has been linked to faster onset of autoimmune disease). In this regard, while the need to specialize will never go away, perhaps it truly is time to think, concurrently, about how we can better generalize.
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