In Britain most people recognise that we need both specialist and generalist physicians because patients refuse to specialise, often having the temerity to complain of problems that transgress specialty boundaries. In this week's BMJ two articles attempt a modern definition of the general practitioner, which in many countries means merely “not a specialist.”
Problems of definition can often be resolved by recourse to a dictionary, and WordNet (www.cogsci.princeton.edu/∼wn/) has the kind of information that the impulsive generalist cannot resist: it indexes “lexical concepts” inspired by “current psycholinguistic theories of human lexical memory.” Its definition of a generalist is “a Renaissance man ... who is in a position to acquire more than superficial knowledge about many different interests.” Apart from an embarrassment of sexist language, that seems a fair definition of the opportunities afforded in general practice.
The concept that stalks all such debates is the self esteem of the discipline; those who have concerned themselves with the issues for long enough usually seem to argue for a separate specialty with its own assessments. Validating these qualifications across Europe is the job of the European Union: at http://citizens.eu.int/ professionals can enter their country of origin and their planned destination, then download relevant information for the transition.
It is not just medicine that grapples with the generalist-specialist problem: at http://home.att.net/[]nickols/general.htm, Nickols argues that the virtue of the generalist is to have integrated several specialties, and that, having integrated them, is more able to bend that knowledge to the needs of the client. The opposite, he rather contentiously suggests, is for the specialist to insist that the client needs what the specialist does. But we wouldn't have that sort of thing in medicine, would we?