title: A historical perspective of the barriers to generalism.
abstract: BACKGROUND
  As early as the late 19th century, there were calls to give greater emphasis to general practice. The momentum picked up after the Second World War. The voices calling for more generalism reached a crescendo in the late 1960s. Optimism was very high in the following two decades. Today, there is a pervasive sense of lost opportunity as generalism continues to languish behind the increasing momentum of specialisation of medicine.
  
  
  OBJECTIVE
  This article is a view of generalism through the lens of history. It seeks to understand and draw lessons from the slow progress of generalism in the light of the forces that have shaped its development through the years.
  
  
  CONCLUSIONS
  The tensions between sectors that promote generalism continue to this day. The ongoing antagonism between the plough, the town and the gown remains a dominant factor that shapes the path to generalism. Political activism seems to be an effective tool in promoting greater generalism.
authors.affiliation: MBBS, MMed (FM), FCFP, FAMS, Associate Professor, Duke-NUS Graduate Medical School; Head and Senior Consultant, Department of Family Medicine and Continuing Care, Singapore General Hospital; Singapore.
authors.forename: Kheng-Hock
authors.initials: KH
authors.lastname: Lee
mesh_terms: D001315:Australia; D058006:General Practice / Q000266:history*; D058005:General Practitioners / Q000266:history*; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D012931:Social Environment; D013038:Specialization / Q000266:history*