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In the distant past in medical education, this was not a subject for discussion. The generalist role was the primary perspective of medical education. With the rise of major medical centers and specialism, medical education no longer preaches from the generalist perspective. In fact, it is very difficult even for family physicians to graduate having experienced the generalist role.
Those accepting the generalist role assume the responsibility to not only serve the patient fully, regardless of their problem, but also assume the responsibility of learning about that area, thus pushing themselves to new heights of integration of medical knowledge, a lifelong process.
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Curricular Dimensions: Multiple
Description
A generalist sees all who choose to come it to visit. Generalists have no restrictions due to severity or type of problem. This often leads to a high degree of uncertainty. The typical vision of this decade is medicine as a well-developed science. In fact it is a system of by guess and by golly. With each advance the level of uncertainty progresses and the need for further explanation and education increases.
Educational opportunities are enhanced when working with a generalist. Rural people seem a bit more comfortable with waiting to come in after enduring the symptoms for a while. Some of them wait a bit long, but in some cases the more advanced state of disease makes for some excellent learning opportunities. The lack of specialists leads to a wider variety of clinical material. Rural physicians are busier, adding to the variety of diseases and conditions. There is often a need to triage - screen for conditions that kill or harm immediately, then those that will do so in a few days, if more then do some tests and wait rather than exhaustive testing of "everything".
This challenge leads to a necessary commitment to lifelong learning. Review of much of medicine must be methodical and utilize many methods. Rural physicians must carve out time to learn.
Access to consultants is critical. They give feedback on what the rural physician knows, what he or she needs to learn. They can be a major source of learning and support.
Generalism, Medical Education, and Family Medicine: Complimentary Not Competitive
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From Mengel's article:
Purposes
Medical History
Philosophy and ethics of medicine
Processes
Interviewing and history taking
Physical examination
Clinical decision making
Clinical management
Health maintenance
Relationships
Doctor-patient
Family system
Cultural issues
Community-oriented care
Health care system
Values
Ethics
Malpractice
Economics
Generalist Courses in US Medical Schools and Their Relationship to Career Choice, Mengel, Davis, Barton, Family Medicine 1992; 24: 234-7
Other references from Mengel's article:
Schroeder GA. The making of a medical generalist Health Aff 1985; 4:22-46
Benson JA Isn't it time for one family of generalists J Am Board Fam Pract 1990; 3:29S-37S
Brucker PC A chance for the generalist? J Am Board Fam Pract 1990; 3:15S-27S
Ginzberg E. Do we need more generalists? Acad Med 1989; 64:495-7