Beyond General Practice: The Health Team

In a group of articles published within the past few years' 7 renewed effort was made to provide status for the general practitioner by extending his training and furnishing him with a more attractive job description. It is the purpose of this article to elaborate the thesis that it is not possible to restore the general practitioner, because of the passing of an era and its social setting, nor is it even desirable in view of vast changes in medical science and knowledge; rather, a new and more realistic format for the provision of medical services which were formerly the general practitioner's rsponsibility is needed and such a program is here described. The general practitioner who knew a community inside and out, who encompassed all existing medical knowledge and skills, who was able to diagnose and minister to physical and emotional illness-from medical training partly, but more from intimate association with the people he ministered to-became obsolescent at the turn of the century. The personal, neighborly figure was attacked, in rapid succession, by the scientific advances of medical knowledge (which made it impossible for one individual to encompass the whole of medical knowledge and skill), by the reformula-tion of medical education on a scientific basis, and by the transformations in American social life incident upon the closing of the frontier: mechanization , industrialization, urbanization, and depersonalization. And if this was not enough, the internal revolution of medical care, occasioned by the above, removed the locus of definitive medical care to the hospital, thereby institutionalizing medical service and freezing the general practitioner out of the main stream of both care and learning.22 Hospitals require staffs of specialists, and for what speciality is the general practitioner equipped? He can only do less than a specialist in any specialty. With the emphasis on standards of training and experience, it would be unfair to patients to offer less well-trained, or less experienced general practitioners as specialists on a specialized service. This would not be acceptable to the house staff, the doctors in training, any more than it would be to the specialists.