Specialisation and superspecialisation have been common in medicine for more than 100 years. While this has enabled significant advances in disease-specific care, it has also led to fragmentation for individual patients, especially those with multimorbidity. Patients often see multiple specialists, which can compromise communication and coordination, increasing risks of overtreatment and medical errors. 

I am not advocating the abolition of specialist care, but my plea is that specialists should act from a foundation of generalism. All doctors need to understand that their treatment goes beyond their own expertise and should consider the whole patient rather than a single organ system. For example, a cardiologist might improve cardiac function, but if the same patient has severe lung disease, the overall benefit may be negligible. This lack of holistic evaluation is a well-documented contributor to overtreatment and poor outcomes. 

As populations age, multimorbidity becomes increasingly prevalent, requiring a more generalist approach to healthcare. Many chronic conditions cannot be cured, so care should focus on quality of life rather than isolated organ repair. Evidence shows that generalist physicians play a critical role in managing multimorbidity by prioritising patient-centred care, relational continuity, and integrated decision-making. 

To achieve this, healthcare systems must rebalance their current emphasis on highly specialised hospital care. Today, the most specialised doctors often hold the highest status, yet they treat only a narrow range of conditions. This hierarchy contributes to inefficiencies and fragmented care. Studies suggest that incorporating generalists into hospital teams improves coordination and patient outcomes, particularly for complex cases. 

Generalism should also be strengthened in medical education. Despite policy initiatives, there remains a lack of clarity on how to train doctors as generalists. International reviews highlight barriers such as the hidden curriculum favouring specialisation and propose solutions like integrating generalist principles throughout undergraduate and postgraduate training. 

Finally, while superspecialists will always be needed for complex interventions, their work should complement—not replace—generalist care. A balanced model combining generalist oversight with specialist input is essential for sustainable, person-centred healthcare in aging societies. 

Short CV Roger Damoiseaux

Roger Damoiseaux is professor in general practice at the University Medical Center in Utrecht. His research areas are infectious diseases in primary care and research in medical education. He is head of the specialty training for general practice in Utrecht and chair of the Dutch consortium of specialty training departments for general practice. From 2016 to 2024 he was a member and vice-chair of the Legislative Board of Medical Specialists (CGS).