Death of the Generalist

I am a specialist.

Or at least, my entry on the medical register in the UK says I am a specialist. Since leaving medical school in 2011, I have been training in first psychiatry and then psychiatry of learning disabilities, until last November I was recognised as having achieved sufficient knowledge and skills in the subject to be added to the specialist register, a prerequisite for being a consultant in the relevant field in the UK.

Although I have an understanding of medicine and surgery, and a more detailed understanding of psychiatry, it is for my knowledge and skills in the psychiatry of people with learning disabilities that I am recognised and ultimately paid. Anyone with an understanding of health care systems will know I am a specialist in a fairly niche speciality. It was certainly not on the radar as a career option when I first applied to medical school.

And yet, despite what my certificates and registration says, I am at heart a generalist. I love knowing a little about a lot, and I find it tiring getting bogged down in the details. Just this week, I have read or watched videos about physics, dinosaurs, philosophy and classical history. They are books and videos produced for a general audience, but I am more than happy with such a level of understanding. I do not need to understand in detail the mathematics of a theory in physics, nor do I need to have read the original source materials on Ancient Rome. (And before you say anything I appreciate the irony of talking about being a generalist having read books written by specialists…)

The idea of finding myself as a specialist in just one area of life, and such a niche one at that, is something which goes against the person I see myself being. Applying to medical school was in part an ill fated attempt to avoid being a specialist (!). Rather than study one subject at university in depth, say physics, I imagined spending my time learning a broad sweep of biology, chemistry, physiology and the like which makes up medicine. In part I was correct, and my education was both broad and at the same time in depth, but it soon began the path to specialisation I had been so set against.

Specialisation has its benefits of course. Anyone with a basic understanding of economics knows that a team of people producing an object are more efficient if each person specialises in a small process rather than everyone learning to do it all from start to finish. Production lines across the world run on this very idea and you cannot deny they produce items are much faster rates that individuals could do alone. Even so, I cannot help feeling something is lost in these specialised factories.

Within the academic world, having someone dedicate their careers to understanding physics or ancient history is a good thing. It allows them the time to truly understand a subject and then share that knowledge with the world at large. If some time was dedicated instead to other pursuits, the outcome may not be as profound. And as our understanding of the Universe grows ever larger, it becomes harder and harder for one person to even begin to understand it all. The idea of the Victorian Gentleman Scientist being able to tackle science, classics and philosophy in an afternoon is long gone (if it ever truly existed in the first place)

Even with this undoubted benefits, I cannot help feeling we are losing something as the world becomes more specialised. Having an understanding of other disciplines and pursuits can have a profound effect on our own work and interests. I do not need to know in detail the history of medicine, but understanding broadly the mistakes made in the past (with asylums in my profession being an obvious example) may help guide us in the future to prevent the same mistakes happening again. When I tackle the thorny issue of consent, capacity and decision making, it helps to know the broad body of literature and thought around free will and autonomy to avoid reinventing the wheel. All of this is without even thinking about the unknown ideas and concepts to be discovered which might just be the solution to problem not considered before.

No matter how much the world is driving towards specialism and specialists, I think we should fight to defend the generalist. Pick up a book on a topic you know nothing about or have previously had little interest in, you might just discover a new love or more. Do not be afraid to know a little about a lot, and certainly do not consider the time learning, any learning, wasted. To badly paraphrase a Mark Twain; I hope reports of the death of the generalist are greatly exaggerated.

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