Sunday, August 25, 2013

Generalist vs. Specialist

Years ago, I was conflicted when choosing my medical specialty. I had always imagined myself as a primary care physician, as a generalist, but none of the specialties that fit that description really resonated with me. Even when I finally chose Physical Medicine and Rehabilitation, I was drawn to it breadth. I felt that it's principal difference from the primary care specialties was philosophical, focusing on function instead of disease. Since starting practice, I have struggled to maintain that breadth. I want to remain a generalist within PM&R, though frequently I have been pushed to subspecialize. In my first job, I was shunted into caring for pelvic pain. In my current position, at various times I have found myself sucked into orthopedic rehabilitation, spinal cord injury medicine, musculoskeletal medicine, adult cerebral palsy care, and medical acupuncture. Recently, I have been delving into performing arts medicine. Through this all, I have struggled to maintain my identity as a general physiatrist.

 Early on in medical school, I heard a joke that went something like this, "A generalist is someone who knows less and less about more and more until he knows nothing about everything; a specialist is someone who knows more and more about less and less until he knows everything about nothing." The dangers of both approaches are evident in medicine. I have seen generalists who can only manage the most basic conditions and end up referring their patients to consultants for almost everything. I have also seen subspecialists so focused that they cannot or will not manage anything beyond the one disease or body part of their focus. Not all physicians fall under these characterization, but it is disturbing how much of medicine has shifted to such specialized care.

My experience thus far in design has been different, though admittedly I am not far enough into it to make sense of it yet. I did go into design with a strong opinion regarding specialization, beyond choosing the discipline of interior design. However, soon after entering the masters program, we were encouraged to start thinking about the specialization for our thesis work. Being a physician, I was naturally pushed towards healthcare design. However, I was surprised how much we needed to learn about graphic design, landscape design, experience design, and urban design. So as I was becoming broader in terms of other disciplines of design, I was becoming more focused within my chosen discipline.

I do not feel that being either generalized or specialized is necessarily better. In both medicine and design, there is room for both. There needs to be constant assessment and adjustment as to the balance between them.