David Haslam: It's better to be a generalist than a specialist

From a speech by the chairman of the Royal College of General Practitioners at the University of Surrey

Isn't it curious how our culture seems to have decided that the smaller the area of your expertise, the higher the esteem in which you should be held? Whether it is the law, or medicine, or other professions, the super-specialist - who knows a lot about a tiny subject - is seen as having higher prestige than the generalist, who has to cope with anything and everything.

Isn't it curious how our culture seems to have decided that the smaller the area of your expertise, the higher the esteem in which you should be held? Whether it is the law, or medicine, or other professions, the super-specialist - who knows a lot about a tiny subject - is seen as having higher prestige than the generalist, who has to cope with anything and everything.

This would be little more than an interesting philosophical discussion if it didn't have a profound effect on medical recruitment and training. Many students enter medical school inspired by, and aspiring to be, general practitioners. Then they are frequently subjected to a flow of prejudicial comments by teaching hospital doctors who put general practice down. Comments like "you seem quite bright, why waste yourself by becoming a GP?", and put-downs about it all being "trivia, like coughs and colds" take their toll, and recruitment to the most difficult of medical specialities inevitably suffers. Some students talk about "I suppose I'll end up as a GP" in a way they would never talk about "ending up as a cardiologist".

There is hardly a GP alive who has not had a new social acquaintance say to them, "So, are you a specialist, or just a GP?" It is that "just" word that drives us to despair. General Practice is the hardest specialty to do well - after all, we are doctors who see patients with unsorted problems, with potentially anything wrong with them. Wouldn't it be more logical to ask our professionals instead the much more telling question: "So are you a generalist, or just a partialist?"