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The future of general medicine: lessons from an admissions ward
1Department of Cardiovascular Medicine, University Hospital, Nottingham.
Objective:
To define the expertise required of general physicians by surveying the work of an admissions ward.
Design:
Observational study during a three-year period.
Setting:
A 30-bed medical admissions ward in a district general hospital.
Main Measurements:
Demography, diagnoses and management of 30,798 patients admitted.
Results:
Patients admitted as emergencies through the admissions ward made up the bulk of inpatients in general medical and health care of the elderly wards. The most common age group was 70-79 years, and there was a slight predominance of men. Fifty-eight per cent of patients came to hospital as a result of emergency ambulance calls, without the involvement of a general practitioner. Cardiovascular diagnoses were most common (40% of patients) but virtually all medical conditions were represented. Twenty-nine per cent of patients were discharged within 24 hours and few were readmitted.
Conclusions:
Management of patients according to different age groups, or by specialties, does not seem feasible. Although specialty expertise is needed in a district general hospital, only a physician with an interest and training in general medicine can handle the scale and scope of medical emergencies. The majority of physicians still need to be 'general physicians with a special interest'.