Should general physicians or subspecialists undertake acute medical care in public hospitals?

Acute medical care in public hospitals may be handled differently in different countries. As general physicians in Singapore are trained to deal with undifferentiated clinical problems and run most of the admitting wards, they are suited to take care of patients with acute medical problems. The exceptions to this rule are made for patients accurately diagnosed with stroke and acute coronary syndrome, who have better clinical outcomes if admitted directly to stroke units and coronary care units respectively. In the diagnostic workup, general physicians are trained to practise probabilistic medicine, and thus to order more focused investigations to rule in or rule out certain diagnoses. The subspecialist is more inclined to exclude possible diagnoses in his or her field. Once there is a clear-cut diagnosis, for primary care, it is up to the patient to decide if his primary doctor should be a generalist or subspecialist. An important role for the general physicians who manage patients with multiple diseases is constant medication review to shorten the list of drugs.