Future development of general internal medicine: a Swedish perspective

Over the past decade, the demands on internal medicine have increased markedly, partly due to an increasing number of elderly patients with multiple diseases. About half of all the cases coming into the emergency units of Swedish hospitals are related to internal medicine, while planned admissions account for only 10% of in-patient care. In our opinion, the fundamental cause of the strained situation in the health care service today is the fact that the emergency care responsibility of internal medicine is not clearly delimited. This means that the specialty must attend to problems in health care that the other health and sick-care services cannot cope with. Furthermore, an overly extensive division of the discipline of internal medicine into subspecialties can lead to inferior treatment of elderly patients with multiple diseases, as well as to increased costs. We believe that an umbrella organisation with overall management of independent subspecialties would make it possible to meet the increased need for internal medicine in a flexible way. In addition, internal medicine could widen its area of responsibility in the border region to surgery, while the demarcation to other specialties in the emergency unit, including primary care, is already very clear today, and should remain so.