"knowing a little about a lot" generalization.

[Dr McSteamy]

Does it offend you when people say you know a little about a lot?

that's actually one of the reasons I want to go into FM.
i like to know a little about a lot, medicine and non-medicine.

if i tell that to a PD, or write it on a personal statement, will that raise (wtf?) eyebrows?
will they think "wtf are you talking about, son?"

 

[lowbudget]

Well... I get a little annoyed when people tell me what I know. You don't know me.

Just put your thoughts on paper for now for your PS. Ink on paper! And edit it from there. I don't know/think it's offensive, because people refer to FM in that fashion either in words, in PS's, or media. I personally think it's pretty cliche and unoriginal, just another one of those buzz words, catch phrases, euphemisms that people use to try to capture FM as a field, but it's quite clear for those who do FM that those words don't really capture 100% what we do.

I mean, to some extent, it does but in other aspect it doesn't. I happen to think EM docs know a little bit about a lot as well. I think in medicine, you'll meet plenty of people who think they know a lot about a lot... when in reality, they know very little about very little.

 

[Dr McSteamy]

nah, i'm not working on my personal statement yet.

just brainstorming every now and then.

I'm just wondering if it's ok to say "i like to know a little about a lot"

or maybe i should say "general knowledge about a lot".

"little" might be belittling huh

 

[Blue Dog]

Actually, I remember the quote as something like: "Specialists know everything about something, while family physicians know something about everything."

A related saying goes: "Internists know everything and do nothing, surgeons know nothing and do everything, psychiatrists know nothing and do nothing, pathologists know everything and do everything- but always too late."

Mark Twain said it best, however: "All generalizations are false, including this one."

 

[lowbudget]

Well, say what you want to say. It is after all a... personal... statement. I know when I was reading those from my side as a resident, I read them pretty quickly. Despite it being personal, most of them are all the same, very formulaic. Something out of the sample essay for the SAT II Writing prep book, or some 5-paragraph expository freshman year writing that was deem A- by a graduate TA. I know mine was. You can tell these are coming from medical students who for the most part are either pretty unimaginative to begin with or had all of that side of their brain cauterized out during med school. These PS's don't read like memoirs or what essayists would write. There's almost always a quote. Or, some analogy/metaphor that my ass can't comprehend post-call. There's almost always either a sick/cool patient encounter, or some family member or personal medical issue, or some health care policy discordance that the writer wants to solve, which defines these melodramatic turning points. There's for the most part a lack of a narrative arc or even a point. I totally understand, because medical people love to doublespeak by asking you to celebrate your individualism... uh, within this tight box of what's considered "professional" and socially acceptable. With med students smack dab in the middle of their training, most people simply play it safe.

Anyways, my point is these PS's are read over pretty quickly and I don't really obsess over word choice as I myself am not a writer. Unless there's somewhat of a truly human voice talking to me from the PS a la David Sedaris, Robert Fulghum, even Randy Pausch. Then I can't wait to meet the writer.

 

[Dr McSteamy]

well, i'm not really talking about my personal statement.

put it this way

Bluedog, or you, or whomever.....

would you think anything of me, good or bad or nothing at all, if I said to your face..... I want to go into FM to "know something about everything." <--- it is mostly truth, aint it?



but since you bring up the PS, mine is not going to be cookie cutter at all. it's going to be very informal and conversational.
I went through so much crap during school, i have a lot of non-boring crap to talk about.

 

[Blue Dog]

would you think anything of me, good or bad or nothing at all, if I said to your face..... I want to go into FM to "know something about everything." <--- it is mostly truth, aint it?

I certainly wouldn't think anything bad.

And, yes...it's actually pretty much true.

It's also one of the big reasons that I went into family medicine (although I also considered other generalist fields, including EM and IM). No other specialty intrigued me to the point that I wanted to focus only on that one area. I enjoyed treating "the whole patient," and still do. Not necessarily all in one visit, of course.

 

[lowbudget]

would you think anything of me, good or bad or nothing at all, if I said to your face..... I want to go into FM to "know something about everything." <--- it is mostly truth, aint it?

Nah I wouldn't care really. I welcome anyone who has a serious interest in FM. It wouldn't start a bar fight or anything, but I wouldn't say OMG, we're BFF's. So to answer your question, it'd be a draw.

My thing (and it's probably just me because I'm a bit odd) is whenever I hear people try to make distinctions between FM from other specialties with the whole "know little/something about a lot" or "jack of all trades, master of none" thing... I just think they're missing the point. Almost like saying something just to say something, you know?

Because to me, it's about knowing/mastering to the best of your ability enough to take care of the patient well. It has nothing to do with a little or a lot. It has to do with doing what's right for them.

Two patients who present in similar fashion can result in dramatically different diagnoses, management plans, and outcomes... all based on some very small subtlety. And, for me anyways, sometimes figuring it out and making decisions based on some of those subtleties require some pretty (IMO) high level thinking and complex decision making. And maybe it's just me, or not being a seasoned veteran, or whatever, but sometimes I struggle with that, especially when the evidence/protocol is not helpful, straightforward, or widely accepted and it comes down to your "clinical judgment". And these may just end up being a pretty big deal (undergo an invasive test, or a big surgery vs. non-op/medical management, or the wrong diagnosis, or a decision that will affect your reputation).

So, whenever I hear the whole "know little/something about a lot" or "jack of all trades, master of none" thing, I don't really think it applies to what I did with Patient X and all the effort, diligence, research, energy, and risk-taking I put into that case.

I mean, to a certain extent, it almost devalues the work I just did, as if to say in a way, knowing little about a variety of things means you should be paid little for a variety of things. I just don't think the generalization is that accurate of a picture. And I don't think people who commit themselves to taking care of patients would agree with that either.

I dunno, does anyone else feel this way? I'm probably just being a wuss (with a "p & y", as one of my attendings told me, ha!)...

Well... you know, that being said, the generalization is a bit generous on other fronts. There're so many things I know absolutely *nothing* about... to say I know even a "little" would be a tall tale, if not an outright lie. Heh!

 

[Dr McSteamy]

So, whenever I hear the whole "know little/something about a lot" or "jack of all trades, master of none" thing, I don't really think it applies to what I did with Patient X and all the effort, diligence, research, energy, and risk-taking I put into that case.

I mean, to a certain extent, it almost devalues the work I just did, as if to say in a way, knowing little about a variety of things means you should be paid little for a variety of things.

that's the response i was talking about. it sounds like you're slightly offended, and I don't want to devalue or offend any superior who holds the key to my future by making generalizations he may not agree with.

if I say "i only want general knowledge about a lot of stuff," I don't want the PD to think "general knowledge eh.....? are you implying that family doctors are stupid and don't know enough?..."

 

[lowbudget]

Call it semantics but I think it's accurate to say that family docs possess general knowledge, but I think it's inaccurate to say they know a little bit about a whole lot per above.

Even if it rides a bit under their skin, it's not the first time they've heard it & you're not the first one who's said it, so it's really a non issue. General medicine isn't exactly being played on the radio these days, so you got to be a little bit more thick-skinned and not overly sensitive to buck the specialist trend (or even IM, the safe route, "to keep options open") to go FM. I doubt something as I consider a non-issue (& at worse a minor irritant) is truly gonna offend someone.

 

[scubadoc78]

This is a great question. I wonder if I could add some...

It seems to me that every FP I've worked with does have a broad knowledge given their training but at any given moment they are sharper or less sharp (never dull, of course) depending on where they're working. For example, I worked with one who had just switched from working full-time in the ER to clinic and she was a bit rusty on health maintenance things (like the generic name of Tamiflu, vax schedules, etc).

I'm doing continuity clinic right now with a less young (not old, of course) attending who is simply amazing after having spent a career doing this. He not only knows meds/techniques that have come into/out of use but he remembers all the history/stories of various medical therapies/drugs plus the shifting paradigms and philosophy that went them.

To me, this speaks to how great FM is. That you can switch from working ER to working clinic to working OB to working inpatient. How cool is that? The downside, however, is you may get some jump to conclusions med student who thinks all FPs are clueless cause they don't remember the generic name of Tamiflu!