The Evolution of British General Practice 1850-1948

By Anne Digby | Go to book overview

11
Generalists, Specialists, and Others

WITHIN a wider medical world inter- and intra-professional disputes over medical terrain meant that the role of GPs, indeed their survival in a very competitive situation, became problematic. The GP was threatened by an expanding municipal health sector spearheaded by Medical Officers of Health, an increasing takeover of childbirth by midwives, and permeable, shifting boundaries relative to the specialist. Would the evolving division of labour leave the generalist in a contracting, residual position as was happening in some other countries? Alternatively, would the growing practice of referral stabilize the relationship of generalists and specialists?

A favourable, if patronizing, verdict on the generalist, was delivered by a distinguished specialist, Sir Clifford Allbutt:

His university was . . . nature; in his clinical experience he enriched the instruction, half empirical, half dogmatic, of his medical school by the shrewd, observant, selfreliant, resourceful qualities of the naturalist. His science, and practice were of the naturalist, not of the biologist. In my early days a country drive with such a doctor used to be one of the rewards of the consultant; and a bedside talk with him a lesson in quickness of wit and hand, and of instructive inference and prognosis; his rules of thumb were not without their efficacy, and his flair for the issues of disease marvellous.1

With the benefit of hindsight we can see that 1920, the date of this comment, marked something of a professional high point for the general practitioner, when previous integration into an expanded range of local medical services and institutions was still relatively unchallenged. Thereafter, the multiple roles of the generalist were increasingly threatened by: the growing speed of medical specialization, and with it the difficulty of keeping up-to-date or of buying expensive equipment; the financial insecurities of small local hospitals which earlier had provided opportunities to bridge the generalist/specialist divide; and the successful take-over of professional territory by rival practitioners. Compensating alternative opportunities for preventive or health work in health centres or municipal clinics were not viewed enthusiastically by most GPs. In failing to adopt a pro-active role 'the "all-rounder" of medical practice' was therefore left 'apprehensive of his fate'.2

____________________
1
BMA, Presidential Address ( 1920).
2
BMJ Supplement, 26 Sept. 1953, 132.

-287-

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The Evolution of British General Practice 1850-1948
Table of contents

Table of contents

  • Title Page iii
  • Acknowledgements vii
  • Contents ix
  • List of Plates, Maps, and Figures xi
  • List of Tables xiii
  • Abbreviations xiv
  • 1 - Constructing General Practice 1
  • PART I - Careers 21
  • 3 - Recruitment, Education, and Training 40
  • 4 - Reinventing Roles 66
  • PART II - In Practice 91
  • The Medical Market 93
  • 6 - Organizing A Practice 126
  • 7 - Women Practitioners 154
  • 8 - Medical Investigation and Treatment 187
  • 9 - Patients 224
  • PART III - A Wider World 257
  • 10 - Public Duties and Private Lives 259
  • 11 - Generalists, Specialists, and Others 287
  • 12 - National Health Insurance 306
  • 13 - The National Health Service 325
  • Select Bibliography 343
  • Index of Medical Names 365
  • General Index 369
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