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General medicine consultation. Lessons from a clinical service.

M E Charlson, R P Cohen, C L Sears

    The American Journal of Medicine
    |July 1, 1983
    PubMed
    Summary

    A general medicine consultation service defined its academic domain by analyzing 564 cases. Key areas included preoperative management of chronic illnesses and diagnostic issues in psychiatric patients, highlighting the service

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    Area of Science:

    • General Medicine
    • Academic Medicine
    • Consultation Services

    Background:

    • A new general medicine consultation service was established to define its academic domain.
    • The service aimed to provide specialized medical support across various hospital services.

    Purpose of the Study:

    • To operationally define the scope and function of a general medicine consultation service.
    • To analyze consultation patterns and patient demographics.
    • To gather data for future educational and research endeavors.

    Main Methods:

    • Retrospective analysis of 564 consultations over the first year.
    • Categorization of consultations by referring service (surgical, psychiatric).
    • Evaluation of service by referring physicians and residents.

    Main Results:

    • 52% of consultations were for surgical patients, primarily for preoperative chronic illness management (hypertension, diabetes, angina).
    • 47% of consultations were for psychiatric patients, often for diagnostic issues (abdominal pain, dementia, thyroid disease).
    • Referring physicians rated the service favorably, though some noted recommendations disproportionate to problem complexity.

    Conclusions:

    • The general medicine consultation service plays a significant role in managing complex patient cases, particularly in surgical and psychiatric settings.
    • The service's educational impact was perceived as stronger in 'art' than 'science' of consultation.
    • Findings provide an operational definition and data to guide future development of such services.

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