What’s the Difference Between General Practice Physicians and Specialists?

doctor and patient.
“Dunno. That’s not my job.”

Photo illustration by Juliana Jiménez. Photo by Shutterstock.

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Answer by Ben Howell, general practitioner, ex-R.N.:

The easiest way to understand the differences between the various specialties in medicine is to identify the health questions they would answer with: “Dunno. That’s not my job.”

Internal medicine and general practice are simply two of the many different types of medical colleges. Other colleges include surgery, anesthetics, dermatology, intensive care, psychiatry, ophthalmology, public health, emergency medicine, radiology, pathology, obstetrics and gynecology, and pediatrics.

Internal medicine specialists belong to the College of Physicians. Physicians are the cardiologists, gastroenterologists, geriatricians, rheumatologists, etc. Physicians focus on the diagnosis and non-surgical treatment of a particular system of the body. They can even subspecialize and focus on a particular organ—for example, some gastroenterologists focus purely on the liver (hepatologists).

As you can imagine, the more you focus on a subspecialty, the deeper your knowledge in this area. If you approach a hepatologist and ask him about your liver, then you’ll have access to a greater wealth of information than if you asked that same question to a general practitioner. However, the more someone focuses on a particular specialty, the more areas of medicine they ignore. If you ask a hepatologist about your eyes, he’ll respond with: “Dunno. That’s not my job.”

There are still some general medicine physicians who dabble in a little bit of each internal medicine specialty. However, there’s a still a big difference between these doctors and primary care doctors. Again, the difference is easiest to spot by focusing on what questions they won’t answer. These physicians don’t see kids—that’s the job of pediatricians. They don’t operate—that’s the job of surgeons. They don’t care for your mental health. They don’t look after your pregnancy. They won’t freeze or excise your skin cancers. There’s lots of things that these physicians don’t do.

General practitioners, more so than any other specialty, do a little bit of everything. They see adults and kids. They look at rashes and broken bones. They answer questions about your heart, lungs, skin, eyes, and mental health. They’ll help you through your pregnancy. They even perform some simple office-based “operations.” If you approach a general practitioner with a basic question about any area of your health, he’s much less likely to say, “Dunno. That’s not my job.”

However, this breadth of knowledge does come at a cost. General practitioners won’t have the same depth of knowledge as a specialist in that area. If you have a medical question that is complex or detailed, then a general practitioner is going to be stumped for an answer well before the relevant specialist. Therefore, when a general practitioner is presented with a problem that is not basic, he will respond with, “Dunno. That’s not my job,” and refer you to a specialist who has the required depth of knowledge.

There’s two ways to look at general practitioners. You could look at their breadth of knowledge, whistle with awe, and think “Wow! Here’s a doctor who can sort out all of my basic medical problems.” Alternatively, you could look at the limitations of their knowledge and think, “I’m not going to see a family doctor. I’m going to see one of every type of specialist for each of my health problems.”

Some people actually do this—usually people with more dollars than sense. However, there’s a few problems with this philosophy.

Firstly, it’s costly. Not just to you, but, also to the health budget of your country. Governments usually contribute more to the cost of a specialist appointments than they do to the cost of family doctor visits. If people decide to use one of every type of specialist for general checkups, then it will consume a much larger chunk of the health care budget than if they do the same checkup with a general practitioner. This is the reason a lot of countries require a referral from the general practitioner before you can see a specialist. The referral is basically an agreement from the general practitioner that you have a problem that he cannot sort out by himself and, therefore, the extra expense to the health care budget is warranted.

Secondly, it’s unnecessary. There’s a saying in medicine: “Common problems are common.” It’s typically a mantra told to medical students to protect against “zebras” but it applies here as well. Your health problems are more likely to be common problems than rare ones. Primary care doctors are very good at handling common problems—they see and treat them all the time. There is simply no need to rush off to specialists for common problems. When you do have a complex or difficult health problem, then your primary care doctor will refer you to the appropriate specialist.

Thirdly, it’s risking that you’ll miss out on the importance of holistic care. The advantage that general practitioners have over specialists is that we see you for lots of different health complaints and get to know you. This is an underrated and massively powerful tool in medicine.

If you suffer with a problem and choose to visit lots of specialists to have it investigated, then all but one will give you the answer, “Dunno. That’s not my job.” For example, if you have chest pain, then your cardiologist will perform some tests and tell you, “The pain is not coming from your heart.” Your gastroenterologist will put a camera into your stomach and tell you, “The pain is not ulcers or reflux.” Your respiratory doctor will scan your lungs and reassure you, “It’s not lung cancer.” A rheumatologist will run a battery of tests and advise, “It’s not an autoimmune disease or originating from your spine.” However, your regular family doctor, who has known you for most of your life, may not need any test results to be able to tell you, “The chest pain is your anxiety.”

General practitioners have a breadth of knowledge about common medical problems—the ones that you are most likely to suffer from. More importantly, they’re the type of doctor who is most likely to know you. Specialists are incredibly important, and primary care doctors will refer to them when your health complaints drift beyond their level of expertise, but it’s important to appreciate there are pros and cons of every type of specialty. The best way to receive quality medical care is to use the right tool for the job.

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