In Defense of Generalists: Primary Care Observations Have Systematic Advantages.

Abstract

There is a perception that physician specialists are the experts, and that generalists, often called primary care physicians, are the 'Jack of all trades, master of none.' However, this perception ignores the knowledge that comes from clinical observations, and it is here where the generalist viewpoint has advantages. Generalists observe patients before and after they develop medical concerns. In contrast, the clinical experiences of specialists are often focused on a subset of the population, typically based on certain concerns or age groups. Seeing only a slice of the population may lead to biased clinical perceptions for the effects of behaviors, conditions, or treatments in the general population. In this commentary we demonstrate that limiting clinical observations to patients who have a certain condition or are above a certain age can make exposures which are harmful seem beneficial, and exposures which are beneficial seem harmful. Using hypothetical examples, we illustrate that there are systematic reasons why generalists who see patients over the long-term, both before and after medical concerns, can have a more accurate vantagepoint.