Jack of all trades, master of none?

Health care systems have traditionally been based on single disease pathways with patients seeing a specialist for each problem. However, with the current increase in the UK of multimorbidity (the coexistence of two or more chronic conditions in the same individual) are there now times that a Jack of all trades, or a generalist practitioner, will provide the optimum care for a patient? 

There have been increasing calls for doctors to consider this, with the chief medical officer, Chris Whitty, advising that it was essential for doctors to maintain generalist skills alongside their specialist ones, to address the multiple pathologies that many people now present with. The World Health Organization’s review of multimorbidity in primary care, called for “expert generalists” to take a tailored, patient-centred care approach for people with multiple conditions. Is it time for physiotherapists to consider a similar approach?

Patients with multiple conditions often have several clinicians involved in their care, with communication between them not always happening in a timely way, or in a way that promotes information sharing and makes navigating care easy for that patient. Service acceptance criteria can often exclude people based on multi-morbidity or lead to teams working in silos treating different parts or conditions of the same patient. 

Conditions that contribute to multi-morbidity are likely to be long-term and require coordinated management to allow that person to function in the best way they can. However, with guidelines and pathways still tending to focus on a single disease or pathology there may be a disconnect between the frameworks and criteria we work under, and the person in front of us requiring physiotherapy. 

Physios have traditionally moved along a career pathway to increasing specialism but as individuals should we now consider refreshing those distantly remembered rotational skills or learn skills outside of our specialist areas to better treat and understand patients with multi-morbidity? A musculoskeletal physiotherapist who can also advise an asthmatic patient on inhaler technique may enable them to progress or start their rehabilitation and prevent that patient from needing another appointment with a different clinician to address the issue. 

Do physios also need to look at additional skills to utilise alongside our core skills? Should there be more focus on a coaching and enabling approach, allowing us to work towards changing health behaviours of our patients? Do our systems allow us to do this? As a profession, we are ideally placed to address self-management and health promotion.

We may see patients with multimorbidity relatively early in their diagnoses, where this advice and approach can slow the progression of conditions, benefiting the person, healthcare systems, and the economy. 

We need to give value to those physios who already have expert generalist skills and create career pathways and roles for those who want to develop them. It takes an enormous breadth of knowledge and competency to walk into a house, or up to a bedside, to assess a patient who may be in their teens or a centenarian, with a range of conditions that require physiotherapy, and know that you’ve got the tools to address their needs. 

There will always be a place in health care for specialist skills and knowledge, however as a profession, we should begin to consider our abilities, pathways, and systems to allow us to address those ‘often times’ for patients with multimorbidity, when a Jack of all trades really can be better than a master of one. 

Further information

Chief Medical Officer’s Annual Report 2023 Health in an Ageing Society 
World Health Organization: Technical Series on Safer Primary Care, Multimorbidity