Abstract
BackgroundRising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care. However, intra-professional boundaries and silos within the medical profession may challenge holistic approaches to patient care.MethodsWe used Q methodology to examine how postgraduate trainees (n = 38) on a range of different specialty programmes in England and Wales could be grouped based on their rankings of 40 statements about ‘being a good doctor’. Themes covered in the Q-set include: generalism (breadth) and specialism (depth), interdisciplinarity and multidisciplinary team working, patient-centredness, and managing complex care needs.ResultsA by-person factor analysis enabled us to map distinct perspectives within our participant group (P-set). Despite high levels of overall commonality, three groups of trainees emerged, each with a clear perspective on being a good doctor. We describe the first group as ‘generalists’: team-players with a collegial and patient-centred approach to their role. The second group of ‘general specialists’ aspired to be specialists but with a generalist and patient-centred approach to care within their specialty area. Both these two groups can be contrasted to those in the third ‘specialist’ group, who had a more singular focus on how their specialty can help the patient.ConclusionsWhilst distinct, the priorities and values of trainees in this study share some important aspects. The results of our Q-sort analysis suggest that it may be helpful to understand the relationship between generalism and specialism as less of a dichotomy and more of a continuum that transcends primary and secondary care settings. A nuanced understanding of trainee views on being a good doctor, across different specialties, may help us to bridge gaps and foster interdisciplinary working.
Highlights
Rising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care
Physicians working in Acute Medical Units (AMUs) in the United Kingdom (UK) provide rapid multidisciplinary medical assessment [4]
A 2011 report on Modern Medical Generalism, commissioned by the Royal College of General Practitioners and the Health Foundation (UK), warns against a simplistic definition of generalists as providing ‘first-contact’ care, adding that there is more to medical generalism than good practice: ‘ the generic attributes associated with good professional practice are an intrinsic part of generalism, the generalist has specific clinical qualities that go significantly beyond this’
Summary
Rising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care. Our previous research indicates that traditional disciplinary structures within medicine (with the conventional split of generalist practitioners in the primary care or community setting, and specialists based in hospitals) can undermine and complicate trainee generalists’ developing sense of professional identity [14]. In this context, what it means to be a ‘good’ (or even ‘ideal’) doctor [15], in the context of an increasing emphasis on hospital-based generalists that threatens to disrupt traditional (and perhaps outdated) hierarchies of specialism, is a question of growing international concern
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