Requiem for a generalist

Jon H. Johnsen

It is a sad statement, but the only part of the CMAJ that I now read faithfully is the obituaries. Recently, one caught my attention: “Rabatich, Stephen, Plaster Rock, NB; McGill University, 1945. Died June 1, 2007, aged 86.”1

Dr Rabatich, affectionately known to us as Rab, was the beloved family doctor of my youth. He delivered me to this world, tended to my ear infections, took out my tonsils, and counseled my family after my mother’s death. He and Captain Hawkeye Pierce were my first medical mentors. (More on what those 2 have in common later.) Rab was the man who made me think I might like to be a doctor. He gave me a reference when I applied to medical school. He gave me my first medical lesson, teaching me where the McBurney point is. He had said to me, “That’s a handy thing to know if you’re in the woods fishing and someone gets belly pain.”

Unique if not specialized

Dr Rabatich volunteered for military service in 1942 before obtaining his MDCM and studying anesthesia. He served as physician, surgeon and coroner in Plaster Rock, NB, for almost 50 years and was often on call 24 hours a day. He was awarded the Dr. Garfield Moffatt Medal in 1986 by the New Brunswick Medical Society for outstanding professionalism.1

We used to line up in the emergency department to see him. He had a crude form of triage. He used to stick his head into the waiting room and look around at all of us until he caught someone’s eyes; then he would extend his arm with his finger outstretched, curling it back and forth, to indicate you were to follow him to the examination room for your visit. He also used to smoke in the examination room (until his coronary bypass, when he was forced to quit). While he was an outstanding professional, he was certainly not always politically correct!

“Dr. Rabatich is survived by his devoted wife of 62 years, Laverne, 2 daughters, Diane and Daphne (John), and 2 sons, Ulrich and Dr. Dusty (Helen) Rabatich.”1

Legend has it that Laverne used to sterilize the bandages for the hospital (then a Red Cross outpost hospital) at home. Without her it is doubtful that the family would have stayed in that small, northwestern New Brunswick lumber town. I think it is fitting that Laverne was mentioned in Rab’s obituary with this 1 word: devoted. We too often forget that without the devotion of their families, many doctors simply would not do what they do.

An evolving discipline

My practice is not a lot like Rab’s was. I am in a large group practice with shared call. I have forsaken small-town northwestern New Brunswick for urban northwestern Ontario. I am now in a position of medical leadership. I cannot say that I advocate for Rab’s type of practice. Am I being unfaithful to the example Rab held up to me? Would he approve of the way family medicine has changed since his career? Is this a change in work ethic of the “new” family doctor, or a reflection that medicine since Rab’s time has changed so much that nobody can work in that way anymore?

Certainly nobody thinks going back to the days of being on call 24/7 is a good idea. However, it does not mean that we cannot learn anything from the example men and women like Rab set for us. We can all continue to show “outstanding professionalism” in the communities we serve.

What did Rab and Hawkeye Peirce have in common? They were generalists. I like to think that in my leadership roles I remain an unabashed believer in the importance of the generalist in our health care system. Whether general family medicine, general internal medicine, general surgery, pediatrics, or psychiatry, I feel there is a crying need for generalists in our system. I am afraid that the tendency to specialize might lead to a generation of doctors who fail to see the big picture.

In the end, I hope that this is a eulogy to Dr Rabatich and not to the generalist as a career.