Why I am Proud of Being a 'Generalist' Physician

December 5, 2014

I am a family doctor, always seeking out ways to see one more patient in the day, finding one more resource, helping one more patient through challenges.

I used to hate the term “generalist.” I felt offended being referred to as a general practitioner. Family medicine physicians often find ourselves having to explain our career choice: As students we are often encouraged to match in other, more lucrative or prestigious, specialties.

Family Medicine is the safety specialty, where you go if you have to scramble. We are underpaid and overworked; yet I believe family medicine doctors are the doctors many medical students aspired to be when they eagerly applied to medical school.

We all wanted to care for people, develop relationships with our patients, to follow them through their care, and make a difference in their stories. We need to know a little of everything as anything can and does walk through our exam room doors.

We need to be generalists, competent in several fields or activities, in order to care for our patients. I am striving constantly to attain this competency since getting to a specialist may not be feasible for that single mom working two jobs or the elderly gentleman with no family to transport him.

Generalists must be innovative, creating a diabetic menu for a patient stretching an income to feed himself and his adult children, grandchildren, and often, aged parents; deciding which test can be deferred for a diagnosis that can be clinically identified; or knowing which pharmacies offer free diabetes supplies and antibiotics.

Last year I moved from a suburban, middle class neighborhood practice to a poorer, urban clinic. My goal to provide full-spectrum family medicine to an impoverished and underserved population has both come to fruition and exhausted me. The challenges I face in this demographic force me to be a jack-of-all-trades.

I never know what my patients may present with and rarely is it actually what the schedule states. Headaches quickly turn into a discussion about anxiety; an annual physical develops into an opportunity for diabetes education.

I care for multiple generations of the same family and an office visit for a toddler's well-child visit may also involve a discussion of mom's contraceptive needs or grandpa's necessary refills.
My patients face various barriers getting to see me, so if I have a captive audience I take advantage of it, even when it means creating three visits out of the space allotted for one.

This does not scratch the surface of the behind-the-scenes work I also do such as completing stacks of paperwork for prior authorizations on formularies that seem to change every six months leaving patients lacking coverage for medications that previously treated their conditions or reviewing charts in search of missed opportunities for preventative screenings or immunizations. I call pharmacies about refills and specialists about missing office notes.

Often I feel lost in the maze of the demands. Medical school failed to provide any lectures on filling out disability paperwork or on providing explanations of medical necessity.

Specialists often won't take my Medicaid or uninsured patients, and even those that do often have long waiting lists. In turn, I have honed my ability to wear many hats. For my patients, who are often barely scraping by, I feel compelled to work a little harder and stay a little longer making sure they get what little they can.

I find myself not just asking my patients about flu shots and medication compliance but also if there is enough to eat or a warm place to sleep. As winter comes in full force, I worry for a recently homeless couple I care for. Despite both of them working, money has been tight and they have been living in their car since the spring. Each time I see them I inquire about food and blankets, trying to make sure they won't freeze in the frigid temperatures.

I have never known poverty such as this and sometimes I am unprepared for it.

A single mother of two children came in overwhelmed after losing her job. Through her tears she explained she had nine dollars to get through the next three weeks, ashamed that she didn't have enough to feed the children. Her WIC supplement provided barely half of the baby food she needed for her 10 month old. She described her depression and desperation, wondering if an antidepressant could help.

If only I could develop a magic pill to fix it all.

In 20 minutes slots I am asked to take care of not just all the physical ailments, aches, and pains, but also the spiritual and mental concerns as well, and I have no magic, cure-all pills. But I am a family doctor, a generalist, innovatively finding ways to see one more patient in the day, finding one more resource, helping one more person through that challenging moment.