Renaissance of hospital generalists

Abstract

Hospital medicine in the US and acute medicine in the UK are the fastest growing specialties in their countries. Robert M Wachter and Derek Bell examine the factors behind their rise and how the differing national healthcare systems have influenced their structure Robert M Wachter professor of medicine and chief 1 , Derek Bell chair in acute medicine 2

Inpatient care: should the general physician now take charge?

“…3 However, the evidence to guide best practice in relation to the delivery of acute care, particularly in the frail, older patient, is extremely limited. Therefore, there is a crucial requirement to promote research and evaluate services to determine which elements of the organisation of care have the greatest impact on patient outcomes.…”

“…Alternatively, extending the role of acute physicians beyond AMU might export to other hospital wards the improvements in mortality and length of stay associated with care on the AMU. 3 Finally, meeting headon the changing demography of inpatients with a hospitalisttype model could mean a renaissance for the largest cohort of generalists in the NHS: the GIM physician. The current cap on NHS funding would favour the last option, as a sufficient expansion in the number of geriatric or acute medicine consultants to meet the care requirements of all patients not triaged to a medical subspecialty is unlikely.…”

“…However, a key difference is that the hospitalist serves as the responsible physician for patients throughout their hospital stay, whereas acute physicians are responsible for care on the AMU for the first 48-72 hours of hospitalisation. 3 Furthermore, hospitalists deliver care to patients requiring their expertise irrespective of their location in hospital, often following patients into the intensive care unit and co-managing surgical patients.…”

“…One notable exception has been the emergence of the field of acute medicine, which has many parallels with the development of hospital-based generalist physicians, or 'hospitalists' , in the USA. 3 In the UK, geriatricians and physicians practising general internal medicine can lay claim to generalist credentials. In this paper, we seek to contribute to the discussion of how the organisation of care in hospital and, specifically, the structure and skills of its medical workforce, can best meet the needs of a population that is becoming older and frailer, with a greater encumbrance of comorbid diseases.…”

Should every adult patient in the hospital have an internist?

“…While it has some similarities to "European" acute medicine, it differs particularly in that it provides continuous care throughout the hospitalization period and even beyond. 1 Not only medical patients, but also surgical patients and patients in psychiatry and neurology wards are now being co-managed by hospitalists in the United…”