International Generalist Physicians' Conceptions of Generalism: "The Way," "The Privilege," and "The Indescribable Whole".

purposeWidespread change toward transactional and technological health care is contrary to the generalist philosophy and is challenging the ability of family medicine physicians to enact its values and meet patient needs. This research seeks to build understanding of generalism by asking international generalist physicians to reflect on the often tacit features of generalism that provide much of its value.

methodsResearchers conducted a 2-phase qualitative study. Phase 1 consisted of Zoom (Zoom Video Communications, Inc) individual interviews with 13 international generalist physicians and researchers. Phase 2 included personal reflections to prompts via an app and handwritten reflections after small group conversations among 89 generalist physicians and primary care researchers at an international family physician conference. Combining data from both phases 1 and 2, we discerned themes in an iterative, reflexive analysis.

resultsAnalyses identified 3 themes: (1) "The Way" of being of the generalist; with subthemes of "anything and everything," "putting all the pieces back together," "walking the journey together," and "widening my small world"; (2) "The Privilege" of emotional connection and gratefulness toward patients for meaningful work, with subthemes of "privilege that touches you" and "privilege of holistic care"; and (3) "The Indescribable Whole" of the valuable, but often invisible and misunderstood essence of generalism, with subthemes of "a great big huge idea," "deep care," and "invisible when done well."

conclusionsThese findings bring to light the integrative, relational, wholistic work of the generalist physician. Understanding, valuing, and supporting these aspects of generalist care could serve as an antidote to health care systems that are increasingly fragmented, impersonal, and ineffective.