Time to take on generalist doctors rather than specialists

There’s a new trend emerging in medicine as we live longer. The pattern of health and disease is changing and that’s causing headaches for doctors and carers.

The number of patients who have two or more medical conditions is rising steadily.

Doctors currently call this multimorbidity, though patient groups prefer the more explicit “multiple health conditions”.

The trend is challenging for the whole medical profession, from general practice and community care to acute and long-term hospital settings.

For decades, medical training has pursued greater specialisation, especially for hospital doctors, and that has improved the way we treat single diseases.

But will patients with multiple seemingly unrelated diseases get left out?

Treating each disease in a patient like it exists in isolation isn’t good medicine as it can complicate and duplicate the work of different doctors, and departments, while results of tests may get lost and notes may go astray within the healthcare system.

A patient may take multiple drugs recommended by different guidelines and see several specialists in isolation.

There’s little or no horizontal ­integration between diseases that often coexist, according to 13 Chief Medical Officers writing in the BMJ.

This will require a shift from old practices, even rethinking some elements of doctor training, practice and research in almost every speciality.

The shift demands ceasing to think about ­multimorbidity as a random ­assortment of conditions to ­recognising it as a series of largely predictable clusters of disease in the same person.

Some of these clusters will occur by chance but many will not be random due to common genetic, behavioural, or environmental factors. Identifying these would be a big step forward.

Diabetes is a good example with this common serious disease affecting the heart, nervous system, skin, peripheral vasculature and eyes.

Diabetologists already provide care for the cluster of multiorgan diseases around diabetes, and some specialities, such as ­geriatrics or general practice, have multimorbidity at their heart.

But the CMOs say we’re not moving fast enough to face a multimorbidity dominated future.

Do we need more generalists? A future specialist without generalist skills won’t be equipped to deal with many patients.

A holistic approach is essential. I’m not saying go back to being generalists but generalism in the medical workforce should be given a greater focus in the selection and training of our doctors and care workers.