The generalist curse | Canadian Healthcare Network – Physicians


Dr. Shawn Whatley

In the days before we were smart, doctors used to name things after famous dead doctors. This gave us Morton’s toe, Virchow’s node, and a million other quirky artifacts. It took decades to break the habit.

Now it is de rigueur to let science name things. But some old names stick: just try forgetting Morton’s poor toe.

In the hole left by Morton and Virchow, generalists rushed to build lists and tools. Evidence-based checklists add an air of specialization. With a list in hand, there is no such thing as back pain. There is only Pattern 1, 2, 3, or 4 pain. Dozens of dementia tools objectify the fact that someone cannot tell you his birthday, or any day for that matter.

Generalists seem to love the tools, checklists, and decision aids. Or perhaps it is the shortest way to approach Morton’s immortality.

Lists and tools help, but they have redefined medicine.

Medicine used to mean anatomy, pathophysiology, pharmacology and a bunch of other scientific fields. Doctors learned how things worked, to diagnose what was wrong, and then treat it.

Now doctors score this or ‘measure’ that. But no one really cares — and almost no one really remembers — how the pathology precisely relates to a patient’s symptoms.

Instead of changing attitudes, maybe we should change the way we think about generalism?

Maybe Robbins Pathologic Basis of Disease would do more than memorizing the latest checklist?

Perhaps generalists could shake the generalist curse by becoming more like walking textbooks of pathophysiology and less like house inspectors? It might be the only way.