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
Getting on the Same Page: Why Australia Needs a National Maternity Early Warning System (MEWS) Chart
Briony A. Cutts, Lucy Bowyer, Nisha Khot, Sandra Lowe, Stefan C. Kane
Data for Equity: Can Linked Administrative Data Inform Pathways to More Equitable Child Health?
Sarah Gray, Shuaijun Guo, Meredith O'Connor, Elodie O'Connor, Katrina Williams, Hannah Badland, Susan Woolfenden, Josie Dickerson, Gerry Redmond, Marnie Downes, Sharon R. Goldfeld
Specialty College Selection: Why Change is Critical to Support a Future Rural Workforce
Matthew R. McGrail, Jenny May AM, Katherine Logan
The number of cancer‐related deaths that could be attributable to spatial disparities in survival in Australia, 2010–2019: a retrospective population‐based cohort study
Charlotte K Bainomugisa, Jessica Cameron, Paramita Dasgupta, Peter Baade
Differentiated and simplified oral HIV pre‐exposure prophylaxis (PrEP) models hold the key to virtually eliminating HIV transmission in Australia by 2030
Tyson Arapali, Sarah Warzywoda, Anthony K J Smith, Curtis Chan, Timothy R Broady, Erin Sullivan, Catherine MacPhail, Mohamed A Hammoud, Alexander Dowell‐Day, Benjamin R Bavinton
Non‐technical errors associated with deaths in surgical care, Australia, 2012–2019, by surgical specialty (Australian and New Zealand Audit of Surgical Mortality): a retrospective cohort study
Jesse Ey, Victoria Kollias, Octavia Lee, Kelly Hou, Matheesha Herath, John B North, Ellie Treloar, Suzanne Edwards, Martin Bruening, Adam J Wells, Guy J Maddern