Fundamentals of general medical practice

In many countries there is a recognized specialist education for general practice, corresponding to those offered for organ specialties. Why, then, is general practice not recognized everywhere as a full specialty? It has been suggested that general practice is characterized by an easily available, continuous, personal, binding and comprehensive care. However, there are also other aspects which characterize this discipline. Firstly it is based on an overall view of health and disease, in which physical, mental, and social factors must be taken into account simultaneously. Secondly the epidemiological world, as seen by the primary physician, is different from those of all traditional specialties. This gives rise to considerable consequences in diagnostic and therapeutic work, as reflected in the predictive values of tests and for symptoms in general practice, when contrasted with specialist practice. Thirdly, the approach to problem solving is also very different. In general practice, it is characterized by thinking in terms of possibility or probability, whereas in specialist practice the reductionistic method is used. A fourth factor can also be pin-pointed. Although the primary physician is responsible for the greater part of diagnosis and treatment of illness in the population, he also co-ordinates the patient's contact with the second and third line services in the hospital and in specialized medicine. Therefore, general practice is an independent medical discipline, which demands its own specialist education.