The scientific basis of medical Generalism

The scientific basis for the various specialties in medicine is strong and is well taught in UK medical schools. This is done by identifying and summarising for medical students the main research which describes and explains the principles of specialist practice. However, ever since 1948, general practice has been the one branch of medical practice which is not taught in this way. Many new doctors qualify believing that general practice is 'hospital medicine outside hospital' and ignorant of important research on general practice as a distinct specialty. This article summarises three research studies showing that psychosocial factors affect the body and influence whether patients live or die. They all occur in the home, family or community and are much more likely to be known to family rather than hospital doctors. Generalist doctors can best see the social determinants of illness, to understand why many diseases occur, and to be able to intervene helpfully. Research clarifies the central role of medical generalists. Both the Royal College of General Practitioners and the Health Select Committee of Parliament have called for this material to be taught in medical schools and the sooner it is the better.