Teaching extensor tendon repair in Port McNeill.
Teaching extensor tendon repair in Port McNeill.
The generalist physician is an incredibly important part of our medical system, and has only recently been re-endorsed within Canadian Medicine.

The concept, training and practice of generalism are very important to enable our best and most cost-effective practice. There is often imprecision around what this actually means, however. There has been a resurgence of discussion about generalism recently. This became crystalised for me when a few of us attended that first World Summit on Generalism in Cairns, Australia in October 2013 (See Appendix A)

Subsequently, there has been much discussion within Canada – led by the Society of Rural Physicians of Canada (SRPC) and the Rural Co-ordination Centre of BC (RCCbc), in collaboration with Australian groups (particularly the Australian College of Rural and Remote Medicine – ACCRM).

Recently, there has been much useful discussion at the BC Provincial FP/GP Privileging Panel around the definition and description of Family/General Practice, both urban and rural/remote.

While these concepts will ring true for FP/GPs, it is well recognized that many specialties and specialists bring a generalist view to their practice.

The most recent definition is provided below, and further discussion will take place in April at the Montreal meeting.

The generalist is a skilled clinician who, serving a defined population, is competent in the relationship-based, person-centred clinical method; integrates a sensitive, skillful, and appropriate search for disease beyond and beneath the presenting symptom/illness; acknowledges uncertainty; utilizes the cure/attenuation/comfort spectrum of illness management; and addresses community health status indices.

The generalist, working collaboratively with the patient, their family and the health care team to optimize care, will provide comprehensive continuum of care throughout a person’s illness experience, and throughout a patient’s lifespan, from pre-conception to death. The generalist understands the central role of the person-physician relationship and competently applies the concepts of evidence-informed care, advocacy and stewardship to improve the bio-psycho-social-spiritual health, regardless of the clinical setting.

With self reflection and peer-assessment, the generalist will undertake continual professional self-improvement.

The generalist will undertake to mentor and teach colleagues to the best of his/her ability.

The generalist will strive, wherever possible, to improve the system of care within which he/she works.

Generalism thus, is more than a wide scope of practice; more than the ability of a practitioner and the health care team to provide ‘specialized’ medical knowledge and skills where appropriate; but supporting full continuity of care through an illness experience by accepting, supporting and guiding a patient’s care from initial contact through to resolution; strengthening the relationship and the person’s confidence, knowledge and self reliance en route.

January 2015

The Second World Summit on Generalism will be held on 8 – 9 April 2015 at the Fairmont Queen Elizabeth, Montreal followed by the annual SRPC Rural and Remote educational meeting .

Appendix B demonstrates the cost savings available with an established approach (albeit a report of American experience). Clinical efficacy has been demonstrated many times in different circumstances.

President, Canadian Medical Association (CMA)