Generalism

Collaboration

Collaboration is inherent to generalist practice as physicians help patients navigate health care systems. Increasingly generalists work in teams within the patient medical home (PMH) model.

Communication

Generalists communicate effectively with patients, team members and colleagues.

Complexity

Generalists manage complex patients. Managing multi-morbidity and negotiating uncertainty are hallmarks of generalist practice in family medicine. Breaking complex histories into manageable chunks by clustering similar illness groups, applying shared decision-making skills and being frank with patients about uncertainty can role-model how generalist family physicians manage complexity.

Comprehensive Care

Generalists provide comprehensive whole-person care by adapting a holistic approach to assessment and management.

Context

Generalists integrate content expertise with context expertise by adapting to the specific circumstances of the individual patient. Context can be viewed through many lenses: patient context, practice context, educational setting, physical location, socio-political and cultural context.

Continuity

Recurrent consultations allow patients and doctors opportunities to understand each other. It is associated with a range of improved patient outcomes including patient satisfaction, improved health promotion, increased adherence to medication, reduced hospital use and lower mortality.

The full article "The Praxis of Generalism in Family Medicine: Six Concepts to inform teaching" will be published in the October issue of the Canadian Family Physician CFP Journal

Collaboration:

Discuss Patient medical home model of care https://patientsmedicalhome.ca
Share -behind-the-scenes’ efforts that are integral to ensuring patient care e.g. referral processes, administrative staff work flows, phone calls to various health facilities and advocacy work between health and social services
Have a list of patients who have experienced care from different specialists and encourage students to discuss with patients how specialists, family physicians and allied health care members contribute differently but cohesively to patient care

Communication:

Ensure respectful communication about colleagues in specialty practice, family medicine and allied health professionals

Complexity:

Help students split problems into manageable chunks
Review patient profiles to cluster illnesses affecting similar systems or with shared underlying pathology
Explicitly role-model shared decision-making when managing complex patients e.g. by discussing agenda-setting
Overtly discuss management of clinical uncertainty with students
Discuss weighing pros and cons of management options in the light of co-morbid conditions

Comprehensive Care:

Use comprehensive care to illustrate the intellectual flexibility and broad knowledge base required to care for patients and families
Discuss the personal rewards and stimulation of providing comprehensive care

Context:

Discuss how a patient’s care might vary if the context changed, for example in relation to access to care such as in urban or rural settings, or by having different types of financial or support systems

Continuity of Care:

Ask students to review the file of patient who has been your patient for a long time and discuss this will them to explore stories of long-term relationships with patients and how this impacted a clinical decision or the physician-patient relationship, including a discussion about personal and professional fulfillment
Contrast this to the students’ experience during short rotations
Show how fragmentation of care negatively impacts patient’s care, for example poor communication between care providers