Medical generalists: connecting the map and the territory

doi:10.1136/bmj.331.7530.1462

BMJ 2005;331:1462-1464 (17 December), doi:10.1136/bmj.331.7530.1462

Education and debate

The NHS revolution: health care in the market place

Medical generalists: connecting the map and the territory

Iona Heath, general practitioner¹, Kieran Sweeney, honorary clinical senior lecturer in general practice²

¹ Caversham Group Practice, London NW5 2UP, ² Peninsula Medical School, Royal Devon and Exeter Hospital, Exeter EX2 5DW

Correspondence to: I Heath iona.heath@dsl.pipex.com

The debate on market reforms must not overlook general practitioners'over-riding responsibility—to recognise and relieve patients'suffering

The first 150 words of the full text of this article appear below.

Introduction

Despite enormous advances within medical science over the past100 years, an under-recognised but inevitable gap remains betweenthe map of medical science and the territory of individual humansuffering.¹ The task of the medical generalist is to make usefulconnections across this constantly recurring gap. All doctorscarry the medical map, albeit with patchy and varying levelsof detail, but only the medical generalist uses it to try andmake sense of the whole human person, transcending all the arbitrarydivisions of specialist practice. Here we explore the role ofthe medical generalist and consider how this might be affectedby current NHS reforms.

Generalist's role

In the initial consultation with a general practitioner, doctorand patient work together to explore the usefulness and thelimitations of the medical map in relation to the territory(or subjective experience) of the patient's particular illness.When the patient has an acute and remediable . . . [Full text of this article]

Centrality of medical diagnosis

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Coordination of care

Social solidarity

Suffering

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