April 13, 1984

Generalists and Specialists-Reply

Author Affiliations

Chapel Hill, NC

JAMA. 1984;251(14):1834. doi:10.1001/jama.1984.03340380019011

In Reply.—  I am sorry if Dr Williams mistook my poetic license for poetry, but I hope that my examples, which were, in fact, based on Dr Fuller's,1 managed to transmit the idea that focusing on one area of expertise may detract from the ability of one to become a proficient generalist. Some of my best friends are subspecialists, and one of them once noted that attending on a general medicine ward made him feel like a "fish out of water." I understood what he meant.I am curious about what Dr Ruane thinks his chief resident represents. A subspecialist? He clearly gives a thorough rationale for not choosing a subspecialist to care for a critically ill patient; the discrepancy between his example and his conclusion is somewhat disorienting. Specifically, Dr Ruane summarizes the attitude I find most distasteful toward general medicine faculty in his last paragraph. This is precisely