[Generalists are needed more than ever].

15 If today you want to keep up with basic and clin‐ ical research, you need to concentrate on a very small field and reach tremendous depths in this very field. And, actually, life is too short to also accumulate the knowledge necessary to do mean‐ ingful scientific work even on closely related top‐ ics. Hence, specialization is inevitable not only in research; it was a prerequisite for the devel‐ opment of our highly complex society with its myriad of different professions, which brought us prosperity and longevity never seen before in the history of mankind. People are fascinated by the word “specialist“. It stands for the person who has got the right so‐ lution to most difficult problems, whose knowl‐ edge and abilities surpass those of the ordinary people, and who is an expert in his or her field. The generalist, on the other hand, is struck by the blemish of amateurism: he knows a lot, and has broad education, but to get an answer for an important question you would probably pre‐ fer the specialist. However, since the specialist has to limit the width of his knowledge in favor of its depth, he runs the risk of progressive con‐ centric contraction of his visual field. Our society can only work, if in all of its sectors generalists co‐ordinate the knowledge of specialists, arrange it, and set priorities. Thanks to his or her wide horizon, the generalist is able to keep in mind the whole thing, to appoint the specialist to the right place, and to distribute scarce resources in a wise and just way. Hence, the generalist is de‐ termined for leadership, as seen in politics and in business, and where almost nobody contests such a division of tasks. In our profession, however, the relationship between generalists and specialists became more and more strained; this especially pertains to the medical school level, where the future direc‐ tions of our health care system are defined. What makes the difference between a generalist and a specialist in medicine? Richard V. Lee1 from Buf‐ falo, New York 1995, published some thoughts concerning this question: he indeed found it much easier to define the specialist than the generalist. According to him, specialists have a focused and demarcated vista; they confine their thoughts and actions, avoiding clutter and vagueness; they are exclusive, expert. Generalists, on the other hand, are hard to grasp and do not constrict their ho‐ rizons. Generalists inhabit a cluttered, untidy world. They are inclusive, welcoming; they know a lot about a lot, and they are always available. The methods used by generalists are the exact ob‐ servation of the patient and the long‐term pur‐ suit of his or her disease. Specialists, on the other hand, intrude upon their patients with the help of their technical instruments; they act invasively. In many cases, the method of choice of the gener‐ alist is doing nothing – mere observation of a pa‐ tient. For specialists, it is essential to always be active; they tend to discard the “undoable“ pa‐ tient and move on to the next procedure. The di‐ chotomy between generalists and specialists in internal medicine is the most important topic today; it will have far‐reaching consequences for the entire medicine. Internal medicine was born on April 20, 1882, when the famous German Professor, Theodor Fre‐ richs, opened the first German Congress of In‐ ternal Medicine in Wiesbaden. In his speech, he declared with pathos which was usual in those times: “We are leaving more and more the unity of the human body represented by internal med‐ icine. It is the duty of internal medicine to hold together all subspecialties. Internal medicine is a broad stream, from which the different subspe‐ cialties branch off as smaller creeks. However, they would dry out in the sand, if they would be sepa‐ rated from the broad nourishing stream.”2 Internal medicine is the epitome of a generalistic subject. However, the enormous development of medical knowledge in the last few decades has made the in‐ creasing specialization unavoidable. The different organ‐centered specialties developed so to speak as the daughters of internal medicine. With their sophisticated techniques and methods, the ex‐ perts of all these fields today achieve diagnoses and treatment results that were unthinkable some years ago. It is therefore understandable that these daughters desperately wanted to emancipate them‐ selves from their internal medicine mother. They Correspondence to: Prof. Dr. med. Rolf A. Streuli, MACP, FACP, Honorary President of the International Society of Internal Medicine, Hinterbergerweg 15, CH 4900 Langenthal, Switzerland, phone: +41‐62‐922‐99‐20, e‐mail: [email protected] Received: April 16, 2012. Conflict of interest: none declared. Pol Arch Med Wewn. 2012; 122 (Suppl 1): 15‐17 Copyright by Medycyna Praktyczna, Kraków 2012 COMMENTARY