Volume 195 - Issue 5
What does the future hold for general medicine?
Author: Alan E O’Connor
Med J Aust 2011; 195 (5): 263. || doi: 10.5694/mja11.10847
Published online: 5 September 2011
Published online: 5 September 2011
To the Editor: I commend Jenkins and colleagues for an engaging article on the future of general medicine in Australia.1 It mirrors a debate that is occurring in many acute-care hospitals, particularly in the context of a nationwide shortage of acute-care beds and increasing numbers of older patients presenting with chronic and multisystem disease.2
Currently, emergency physicians see the majority of acutely unwell patients who present to Australasian hospitals, particularly large urban centres, which is of great benefit to these patients.3-5 Thus, creating a new specialty of acute-care physicians to look after these undifferentiated patients seems like unnecessary duplication of service. Indeed, this duplication is one of the main issues in the journey of patients through the acute-care hospital system, particularly in tertiary institutions.
After presentation to an acute-care hospital, patients often experience multiple consultations in multiple venues before admission to a home medical ward. They are often seen by a junior emergency doctor, then a senior emergency doctor, then a registrar from a subspecialty, and finally by the general medical registrar — and only then are they “admitted” and the often lengthy wait for a hospital bed commences.
This journey could be dramatically improved by a single emergency department consultation with a senior emergency doctor (registrar or above), with stabilisation and immediately necessary investigations being done at that stage. After this, the patient could be either discharged to the community or admitted directly to a home medical ward where they can be seen by the home inpatient team. This would abolish much of the duplication that currently occurs and ultimately make the hospital visit safer for the patient and more cost-effective for the hospital.
Competing interests
No relevant disclosures.
References
- Jenkins PF, Thompson CH, Macdonald AB. What does the future hold for general medicine? Med J Aust 2011; 195: 49-50. <eMJA full text>
- Australian Institute of Health and Welfare. Australia’s health 2010. Canberra: AIHW, 2010. (AIHW Cat. No. AUS 122.) 0_pgfId-2407942
- Kontos MC, Kurz MC, Roberts CS, et al. An evaluation of the accuracy of emergency physician activation of the cardiac catheterization laboratory for patients with suspected ST-segment elevation myocardial infarction. Ann Emerg Med 2010; 55: 423-430. 0_pgfId-2407947
- Boyle AA, Atkinson PR, Ahmed V, Kark WW. Emergency physician performed rapid sequence induction and system changes reduce time to intubation in critically ill emergency medicine patients. Eur J Emerg Med 2008; 15: 243-234. 0_pgfId-2407954
- Donald KJ, Smith AN, Doherty S, Sundararajan V. Effect of an on-site emergency physician in a rural emergency department at night. Rural Remote Health 2005; 5: 380. 0_i1140157