After rotating through so many specialties and now halfway done with residency, I realize even more the value of the generalist physician. This may seem easy for me to say as a hopeful family doctor, but every time I rotate through a specialist office (currently on surgery), my belief only grows.
No one understands the whole patient or sees the big picture better.
The value of broad-based training is hard to measure in some way, which is part of the problem. One way I see it is that the generalist has a better picture of how all the pieces fit together in a puzzle. If you’re not hyperfocused on one piece at a time, in a way you have a better view.
One problem is many specialists don’t realize how little they actually know, whether it’s about their patients as a whole or regarding their knowledge of medicine outside their field of specialization. The ENT doctor who wants to give a patient oral corticosteroids for an extended course to shrink a nasal polyp down in size may not be thinking about how the drugs will adversely affect the diabetic’s poorly controlled sugars or make him pack on semi-permanent pounds he can’t afford.
The other problem is that many patients don’t realize these things either. They may not understand the cognitive requirements of a family physician having to start with the broadest differential diagnoses through all organ systems. They may not see the behind-the-scenes coordination. And to do all of this in a highly efficient juggling act that best reflects the patient’s values. Fortunately, a lot of patients who navigate the healthcare system do value their PCPs greatly.
Some more enlightened specialists do recognize their limitations and respect their primary care colleagues a great deal. Others like to bash the generalist doctor who may have missed something because it makes them feel better about themselves, and they love to make sure their patients know.
Family medicine should be the most competitive field of medicine. To see that plastic surgery and dermatology are the most competitive fields right now says a lot about our lopsided and poorly designed health care system. Whoever thinks mid-level providers could replace family physicians is even more misinformed – if anything, NPs and PAs may actually be better suited in a specialist’s office, where they only need to focus on a narrow range of problems limited to one organ system.
Family doctors deliver babies, resuscitate newborns, treat kids, teenagers, adults, and take care of the dying. It’s what some call “cradle to grave” medicine. Family physicians must act as the truest diagnosticians, ready to solve daily mysteries that walk through their doors. Let’s hope our health care leaders, politicians, and policymakers get smart and recognize this reality. Let’s hope our medical schools and residencies do better about attracting the best and brightest students to primary care. Our lives depend on it.