Changing patterns of disease on an inpatient medical service: 1961-1962 to 1981-1982

To assess changes in disease on an internal medicine teaching service, the records of 292 patients admitted to University Hospital, Denver, Colorado, in the academic years 1961-1962 or 1981-1982 were reviewed. It was hypothesized that patients admitted more recently would be older, more chronically and catastrophically ill, and more likely to have multiple illnesses than patients of an earlier era. Over time, length of stay and mortality rates decreased and acuteness of illness increased, whereas age, chronicity, and co-morbidity remained constant. Changes in the prevalence of some common diseases reflected evolving medical and social influences on hospital use. Modern medical residents are exposed to more patients for a shorter time. They see more acute illness but less of the ongoing process of diagnosis and treatment. Awareness of such changes can help educators design residency programs that better prepare internists for practice.