I cherish practicing the nuances of my role, a big part of which is to intervene at the right time and with the right intensity. I seek to find for my patients what is enough but not too much.

The goal is to be in the sweet spot of what is “just right.”

Spending time with my patients and cultivating a relationship over years are my tools to accomplish this. Trust is the basis of my model of care.

A good generalist knows practice guidelines are meant to serve as a support. The actual course of action should be crafted around the individual situation. Learning from the patient’s story and learning what’s important to them will always lead the way for the generalist.

We generalists are the ones with the opportunity to act early and intervene in ways that prevent problems. Safe and simple techniques are more applicable early in a process, and they are better known to the generalist. For example, there is only intuitive data that really caring for the patientworks, but we don’t hesitate at the lack of empiric data with things like this.

These intangibles are principally our domain. We know that careful and honest communication is foundational. We know lifestyle changes are the safest and most meaningful interventions there are. We know that health is not to be found in little orange-shaded containers. Sometimes prescriptions are necessary and thank goodness they are available, but to a generalist they are a last resort and never given alone.

The biggest accomplishments come when we learn something as a result of a health problem. When a health situation lights a fire in a patient and they embrace the need to grow, it is working perfectly.

We have control of our health, to a huge degree, through very simple things:

1. eating whole foods 
2. moving around a lot each day (sweating is good!)
3. avoiding toxins (tobacco is the leader of the pack)

Know that. It is in the realm of the generalist to work with a patient to incorporate these. A patient may even grow to discover that true peace comes not from physical health but rather spiritual perspective.

These are the realms, goals, tools and techniques of the generalist.

Pandemic

In today’s public discourse the generalist’s voice is under amplified, to all of our detriment. It’s the way the system is set up, and because of it, things are missing from the conversation.

Let’s rectify that right now. It’s not that easy to do so on a large scale, but we can do it amongst ourselves on behalf of what is lacking. The generalist’s voice would be politely and consistently driving home these critical points:

1. We are healthier with whole foods and exercisewhich greatly combat the comorbidity that drives mortality, with COVID and anything else. The government should learn first to define what constitutes healthy food then support access to it. We can help educate them. 
2. A group of clinicians treating patients should lead dialogue and research. The perspective of physician leaders networking with other doctors to find treatment solutions should be the most relevant physician voices in the media and in the government, not physician corporate board members. 
3. Good air matters. Pollution is a problem that is contributing to mortality. Relatedly, good air ventilation and healthy light in hospitals, convalescent homes, and residences cannot be ignored.
4. Let’s place respect for the body’s intelligence at the cornerstone of our wisest approach. Natural immunity is robust. Let’s appeal to the Good in each other and recognize the capacity to act in our collective best interest, freely. Let’s motivate with education not fear. 
5. The blockbuster interventions are important and will be promoted but not at the exclusion of the less manicured interventions like vitamin D, Quercitin, zinc, human grade ivermectin, vitamin C, aspirin, etc. These repurposed drugs and supplements are generalist territory. The examples of physicians using them to impact Covid will never get the curated attention that comes with expensive, multi centered, blinded randomized trials from a major proponent, but it’s not an “either/or” situation. All are welcome.

Covid update

• Nationally, the seven day average continues to drop and is now just over 85K daily cases. Last week the average was 100K cases per day down from 110K cases per day the week prior and 130K the week before that.
• The Berkshire case load had a bump up this week. We rose to 190 cases in the last seven days. We increased from 133 cases last week. There were 140 the week before and 184 and 183 cases the two weeks prior to that. Massachusetts numbers are falling, and I’m wondering if this week is a last blip before we too continue to drop case counts. Stay alert. Be smart.
• Twindemic report: I read a report this week with some interesting predictions for another mild flu season. The Southern Hemisphere reported another minor flu season this year, similar to last year. Traditionally that can be used to predict what we will see. All bets are certainly off but I’m starting to wonder if there just isn’t room for two superstars on center stage at one time. Nobody is suggesting to take the winter lightly. A little encouragement that we will eventually be ok is always welcome. In any event, the show must go on!